Editorial Comment

International and national health policies emphasize support for self-management, self-care and empowerment of individuals and populations. In these policies, the values on which these issues are based are not always clearly defined. Emphasis on self-management, self-care and empowerment, however, can be seen to be based on the value of the individual human being who is capable of understanding the meaning of health, cognitively processing information, and acting to promote his or her own health. Health care professionals have an important role in the support of patients’ own cognitive resources: they need to guarantee the availability and evidence-based quality of knowledge, support the processing and structuring of that knowledge, and know how to use it. In the nursing field it is difficult to identify any nursing action for which supervision of patients does not exist. This is especially important in health pro motion and patient education. The ethics of health promotion has its roots in the Ottawa Charter1 of 1986 and, in recent years, the need for an ethical agenda for health promotion has attracted some attention. The ethics of patient education has, however, not often been discussed, although interesting openings are appearing.2 In the support of patients’ own cognitive resources and their use of them, at least two ethical dimensions can be identified. The first has to do with the evaluation of existing relevant knowledge. How can nurses know if they can trust this knowledge and educate patients based on that knowledge? The basic assumption is that professionals work only with right and true knowledge. Yet what kind of knowledge is right and true, or wrong and not reliable? A minimum requirement is to understand the multidimensional nature of health-related knowledge and theories of truth, and to select knowledge based on these. Most important is to tell patients of the origin and evaluation criteria of the knowledge, and to supervise them to find, evaluate and select knowledge for themselves. Very often, professionals inform patients without giving them much opportunity to discuss different alternatives, possible risks, or outcomes of solutions. They behave as if there was only one truth that patients need to follow. In many cases, however, there are alternatives. Evaluation of knowledge for patient education has to do with evidence, currently a popular topic in nursing literature. Evidence, however, is also a multidimensional concept and sources of evidence have been described on different levels. In patient education, relying on only one level of evidence can cause problems; even if we seem to have strong research evidence for certain actions, individual patients may not necessarily be committed to carry out these actions. In patient education, the ethical base consists of a strong research foundation and also a robust respect for individual experiences. The second ethical dimension has to do with the support of individual patients in their processing and structuring of the knowledge and their use of it. Nurses need to know different ways of processing; they must have understanding and respect for different cognitive structures and factors influencing these structures (such as cultural