health promotion ethics

Introduction

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

	Raising issues that the client has not explicitly asked to be addressed
	Sex talk is ‘taboo’ and some behaviours may be distressing to discuss
	Sexually transmitted infections when faced can open a ‘can of worms’.
	Under-age sex is common and needs careful handling
	HIV is commonly surrounded by fear, ignorance and discrimination

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.

	Will I be creating harmony in clients, enabling them to choose freely for themselves, directing their own lives?
	Will I respect their autonomy even if I disapprove of their actions?
	Will I respect all people equally, without discrimination.
	Will I be serving basic needs before any other wants?

Questions about duties and principles

	Will I be doing good and preventing harm?
	Will I be telling the truth?
	Will I be minimising harm in the long term?
	Will I be honouring promises and agreements?

Questions about consequences

	Will I be increasing individual good?
	Will I be acting for the good of myself?
	Will I be increasing the good of a particular group?
	Will I be increasing the social good?

Questions about external considerations?

	What is the most effective and efficient thing to do?
	What is the degree of risk involved?
	Is there a professional code of practice which has a bearing on this?
	Have I got the facts right?
	Are their legal implications and if so do I understand them?
	What are the views and wishes of relevant other people?
	Can I justify my actions in terms of the evidence before me?

Conclusion

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.