Ethics for Health Promotion and Health Education

Ethics for Health Promotion and Health Education discusses ethical principles and interpretations by classical ethicists as they apply to health promotion and health education. The book unpacks ethical expectations in promoting and teaching health in both the classroom and as a researcher or practitioner and then applies the code of ethics using case study methods throughout. This informative text was written by health educators and practitioners to assist health educator and practitioner communities.

• Reviews comprehensive ethical principles (autonomy, beneficence, maleficence and justice)
• Provides the reader targeted applications of ethics to health education and health promotion following the CNHEO revised code of ethics for health education specialists
• Presents practice and application at the end of each chapter to challenge ethical thinking related to health education and promotion

• Language: English
• Publisher: Academic Press
• Release date: Sep 1, 2023
• ISBN: 9780323952309

Book preview

Chapter 1: Introduction to ethical history and principles

Abraham R. Vogelzang    Calvin University, Grand Rapids, MI, United States

Abstract

The aim of this chapter highlights ethical thinking over the millenniums. The chapter reviews some examples of philosophical ideas about ethics by the ancient Greeks and Romans. It presents examples of more modern ethical schools of thought that permeate some of the professional codes of ethics today, including those that apply to health professions.

Keywords

Ethics; Morals; Good; Justice

There may be many who believe that ethical behavior is intuitive. They may believe that doing right is inherent, passed down through generations. Ethical behavior just is; no need to overthink it. For example, communities can agree about doing the right thing well. Conversely, communities can agree on what actions are wrong or bad. Some may believe ethics is the framework or theory that codifies what is good and unacceptable. Others might think ethics is the process of deciding what conduct is good and what acts are wrong.

Central to any discussion about ethics should be an exploration of how a society concludes that certain conduct is right and other conduct is not right. Are there universal standards or criteria that all people accept and use for what is right and wrong? For example, many agree that stealing property from another person is wrong. However, is confiscation of stolen property from a criminal stealing? Is it wrong for the mythical Robin Hood to take property from oppressive, wealthy nobles? Or stated another way, was there consensus throughout the society at the time of Robin Hood that his redistribution of wealth was wrong?

As a general statement, there is probably more or less of a consensus that ethics defines what acts are good or bad or provides guidance on what behavior is acceptable and what is not. It is common to characterize the right conduct as ethical or moral. Audi (2005) states that the general study of goodness and the general study of right action constitute the main business of ethics (p. 284). The Oxford Dictionary (1992) defines ethics as moral principles that govern a person’s behavior or activity. Similarly, the Merriam-Webster Dictionary defines ethics as a theory or system of moral values (The Merriam-Webster Dictionary, 2022).

Kidder (2009) states that "standard definitions of ethics have typically included such phrases as ‘the science of the ideal human character’ or ‘the science of moral duty’." These definitions are similar as they all lean heavily on morals to explain ethics. So, the question becomes how does society decide what is moral or ethical? The answer to this question has been discussed and has been a matter of study for ages.

Early thinking about ethics

Ancient Greek philosophers were some of the first to think about ideas reflected in ethical thinking today. Indeed, the English word ethics comes from the old Greek word ēthikós (ἠθικός), meaning relating to one’s character, representing character, moral nature (Liddell & Scott, 1889). Most people have heard about Greek philosophers like Plato and Aristotle, or words like stoicism, utilitarianism, or relativism. While it is not the purpose of this chapter to provide a comprehensive compilation of how ethical thought developed over the centuries, it is helpful to touch on some of the early philosophical thinking about ethics to better understand today’s use of ethical codes in professional settings.

When thinking about ethics, early Greek philosophers like Plato focused on happiness as fundamental to living well and spoke of wisdom as the highest good (Frede, 2017). Concepts like highest good or justice or even happiness and living well are all ideas discussed around 400 BCEE by Plato yet surface again today. Plato focused on the good, which included the concept of unity or a consistent structure to achieve the highest good. He also explored the concept of virtue, its relationship to wisdom, and how it relates to justice and a structured soul. Plato further concluded that there are fundamental virtues of good people, which he characterized as prudence, fortitude, temperance, and justice (Duignan, 2011). Over 2000 years later, we continue to advocate for justice with steadfast resolve (fortitude).

For Socrates, self-knowledge was an essential good (Williams, 2014). He proposed that a person must be aware of everything about his existence, even its context, to have self-knowledge. He believed that people would naturally do what was good if they knew what was right. For him, evil only resulted from ignorance. Knowledge was a virtue and the same as joy. According to his thinking, wise men will know what is right, will do it, and be happy (Parry & Thorsrud, 2021).

Aristotle developed this early ethical thinking by suggesting that the best possibility for a happy life would be a life in which rationality or logic governs. For him, the highest virtue of wisdom would combine the highest principles and the ability to reason deductively from them. He discussed character virtues and intellectual virtues. He explored what it meant to do the right thing, idealizing the right thing at the right time in the right way concerning the right people (Duignan, 2011). Again, the concept of rationality, high principles, and doing the right thing surface when thinking about ethics today as alluded to in the Code of Ethics for Health Education Specialists (HES) (CNHEO, n.d.) (Fig. 1):

Health Education professionals are dedicated to excellence in the practice of promoting individual, family, group, organizational, school, community, public, and population health. Guided by common goals to improve the human condition, Health Education Specialists are responsible for upholding the integrity and ethics of the profession as they perform their work and face the daily challenges of making ethical decisions. Health Education Specialists value equity in society and embrace a multiplicity of approaches in their work to support the worth, dignity, potential, quality of life, and uniqueness of all people (CNHEO, n.d.).

Fig. 1

Fig. 1 Core constructs of Plato, Socrates, and Aristotle.

Selected ethical schools of thought

Over the centuries, ancient Greek ideas about ethics have influenced the development of Western ethics, and those ideas continue to influence schools of ethical thought today. Indeed, several branches of ethical study or categories of ethics are still widespread, and it will be instructive to briefly touch on some of the more widely held schools of ethical thinking today.

Deontology

Deontological ethics holds that the morality of an action should be based on whether that action is right or wrong under a series of rules and principles rather than on the consequences of the action. It is associated with the concepts of duty or obligations and is sometimes referred to as rule-based ethics where the means is more important than the end (Timmons, 2012). Under this school of thought, action is judged as good or bad on whether it meets universal moral rules or duties. This ethics of duty theory contends that the right things are done for the right reasons (Forrestal, 2016).

Deontological ethics is associated with the thinking of Immanuel Kant (1724–1804) who advocated that people have ethical duties to themselves and others. Kant’s ideas lead to the belief that universal laws apply to everyone throughout space and time (Timmons, 2012). Another Kantian maxim is that rational beings are not just a means to an end: They are the ends themselves (Kant & Abbott, 2009). In other words, personal value is not relative, and no one has more or less value than anyone else. This leads to discussions and beliefs about individual rights, the intrinsic value of individuals, and the rightness or wrongness in an act itself. Thus, any right act is good because it is inherently honest or just, or it fulfills a duty regardless of the outcome (Forrestal, 2016). Putting this in a contemporary context, we should always be completely honest even if the truth harms others.

Consequentialism

Unlike deontological ethics, ethical consequentialism falls more on the practical side. Under this school of thought, the result determines right or wrong (Rogers & Braunack-Mayer, 2009). The essential difference of consequentialist moral thinking is the weight it gives to the consequences or result of the conduct in evaluating the rightness and wrongness of actions. Under consequentialist theories, the results of an action or rule generally outweigh other considerations (Timmons, 2012). This theory is in direct contrast to the adage honesty is the best policy.

This ethical theory reveals the influence of Plato and Aristotle by postulating that the right action tends to result in good consequences and the wrong action tends to result in bad consequences. However, consequentialism would also consider the personal goal of the act (what was the act’s purpose), the long-term effects on others or society, and the potential costs and benefits of the act (Forrestal, 2016). An example of consequentialism is the related ethical theory of utilitarianism which holds that moral acts whose consequences provide the greatest good for the greatest number of those affected. Another example of consequentialism is Hedonism which characterizes acts as good if the consequences result in pleasure or avoid pain (Kraut, 2007).

Virtue

Virtue ethics is another ethical school of thought dealing with goodness or wrongness. Here, the quality of a person’s character—the good quality of character—controls rather than the nature of the act or its consequences. Virtue controls moral good, and its actualization in life leads to good or rightness (Swanton, 2005).

Similarly, vice is the moral opposite of virtue and leads to bad or wrong behavior. Further, virtues are seen as character traits central to a person’s personality. In other words, virtuous traits in a person result in a good person, and a person with traits of vice makes the person bad. People of virtue are viewed as moral agents, and what is right depends on what people with virtuous characters would do in the circumstances (Forrestal, 2016).

The concept that virtue is fundamental to identifying what is good or right was adopted not only by the Greeks (for example, Plato’s fundamental virtues above), but virtue was also important to the Romans. Romans of good character were expected to possess virtues and pass them on to future generations as part of the mos maiorum; ancestral traditions which defined what it meant to be Roman (Kenty, 2016).

This foundation for virtue ethics also carried into the Middle Ages (Moelker & Kümmel, 2007). Knights were seen as men of character and virtue. Traits seen as knightly were those of good sense, honesty, loyalty, protection of the weak and poor, not arrogant but humble, accomplished, prudent, generous, and courageous. On the other hand, they did not demonstrate vices like brutality, pride, worldliness, or personal ambition (Nakashian & Franke, 2017). It is interesting to note that virtue discernment occurred between 476 CE to the beginning of the 14th century, they still ring true and worthy of practice (Table 1).

Table 1

Virtues considered fundamental to being a person who does the right thing or is good is also central to religious and spiritual belief systems (Hare, 2019).

Skepticism

Those who adopt skepticism, or more particularly when it comes to ethics, moral skepticism. land on the other side of those who look to virtues to find ethical standards. Moral skepticism, at its core, holds that no one has any moral knowledge and might even claim that it is impossible to have moral knowledge. Throughout history, as philosophy and science developed, there have always been those who are doubters (Duignan, 2011). Doubters regarding ethical principles and various theories and applications continue today.

Ethical skeptics challenge common beliefs but can differ in the kinds of common beliefs they doubt. For example, they might doubt categorical or absolute moral beliefs without doubting weaker kinds of moral beliefs. They can also differ in the kinds of doubts that they raise (Sinnott-Armstrong, 2019). A well-known moral skeptic is Nietzsche (1844–1900) who believed that moral beliefs prevented living the best life.

Care

The ethics of care is a newer ethical theory emphasizing relationships, interconnectedness, and harmony. Care under this thinking is an end, and caring practice is important to human life (Forrestal, 2016). The ethics of care is attributed to Carol Gilligan, an American ethicist, and psychologist. Gilligan argued that women approached ethical problems differently from men (McHugh,