The World Health Organisation defines health promotion as;
....the process of enabling people to increase control over and to improve their health.
Strategies and methods employed to promote sexual health need to be respectful of the complex determinants of health i.e. Socio-political, psychological, spiritual, cultural factors. Sexual Health promotion cannot ignore the interplay of ethical, moral and legal implications for both the professional and their clients. Some definitions of terms may be helpful;
Morals: The domain of personal values and rules of behaviour. Rules of conduct regulating our social interactions. Culture specific mores, grounded in religion/ideology.
Ethics: The collective belief and value system of any moral community, social or professional group. It is the science of morals involving applying moral principals to practical situations
Problems: Difficult matters requiring solution
Dilemmas: Choices needed between undesirable alternatives
Quandaries: Perplexed states of practical uncertainty over alternative choices.
All of the above abound in our work. The pluralistic society within which we live means that the variety of cultures and lifestyles that exist simply serve to create tensions and conflicts when seeking to legislate for sexual behaviour. The picture is constantly changing too as values and attitudes are moulded and refined. Our work may put us in contact with the full range of human diversity and whereas a non-judgemental attitude is essential this is not easily achieved. If stereotyping of clients is to be avoided the concept of sexual diversity needs to be fully embraced. Acceptance of others will be easier when we ourselves have an acceptance of our own sexuality and an appreciation of how it has been shaped by biological, psychological, social and spiritual factors (Curtis, 1995).
Some ethical issues commonly raised in sexual health promotion
So where does this leave us?
All of this can seem a little scary especially if working in the health Service in general or the GUM clinic in particular with all the potential for major upset. It is important we do not ignore legal implications though at the same time it is worth reflecting on the fact that very few practitioners will fall foul of the law. The moral and ethical dilemmas can cause anxiety especially when our intervention may be challenged by others. For example how do we respond when sex education in school is thought by some to just condone illicit sex? How directive should our advice be when helping someone make a decision about a termination of pregnancy? Should people be given the facts and left to decide for themselves? Should we be actively trying to change attitudes and lifestyles? Ewles and Simnet (1995) pose the following helpful set of questions to examine if faced with ethical dilemmas:
Questions fundamental to decisions about health.
Questions about duties and principles
Questions about consequences
Questions about external considerations?
It is imperative that promoting sexual health is seen as an activity that has legal and ethical implications. The competent practitioner is a reflective one. There will always be a measure of risk taking and if calculated correctly should reap dividends with a professional approach. When it comes to promoting sex many individuals see the need for it but few are confident to embrace it as an integral part of their role. Training opportunities exist to better equip professionals to meet the challenge of promoting a healthier sex life for their clients. Supervision is also of vital importance if we are to get the support needed to continue the juggling act our roles often demand.
Burr, M. (1982) The Law and Health Visitors. Edsall and Co.
Curtis, H. (1995) Sexual Health Promotion in General Practice. Radcliffe Press.
Edwards, S.D. (1996) Nursing Ethics a Principle Based Approach. Macmillan.
Ewles, L and Simnett, I. (1995) Promoting Health: A practical Guide. 3rd Edition. Scutari Press
Montgomery, J. (1997) Health Care Law. Oxford University Press
Samuels, A. (1993) The Legal Liability of the Nurse - the lawyers view. Med.Sci.Law. 33(4)
Thompson, I., Melia, K., and Boyd, K. (1994) Nursing Ethics. Churchill Livingstone.