The Influence of Ethical Theories in the Practice of Health Education

Health educators increasingly need to have an awareness and appreciation for various ethical traditions as they develop and implement interventions that serve disparate populations, representing different cultural, racial, and faith traditions. Informed consent, right of privacy, confidentiality, anonymity, beneficence, nonmaleficence, respect/autonomy, justice, and others are often cited as principles in health education practice (Beauchamp & Childress, 1994; McDermott & Sarvella, 1999). Perhaps as important for the practice of health education is the need to understand the ethical traditions from which these principles are derived. Ethics is a systematic body of knowledge whose subject matter is human conduct. An ethical theory provides a framework whereby an agent is able to evaluate whether human actions are acceptable. Whereas health education curricula emphasize the social sciences, which describes human behavior as it is, ethics reflects on what ought to be done. Well-known types of ethical theories include natural law, utilitarianism, Kantianism, liberal rights, cultural relativism, and others. In addition, evolving out of the metaethical project initiated by G. E. Moore, are intuitionism, emotivism, prescriptivism, descriptivism, and contextualism. Metaethics concentrates on the language of moral discourse and has moved away from normative ethics, which focuses on the action and the agent. Adherence to any of these ethical theories has implications for health education practice. Health education necessarily entails engagement in controversial areas, where proposed solutions to perceived health problems, consciously or unconsciously, originate from an ethical tradition. Health educators have ethical frameworks that guide their behaviors and what they think is right or wrong, good or bad, normal or not normal. The Health Education Code of Ethics can further assist in serving as a guideline. Dissonance may occur, however, when a health educator encounters someone from a different ethical tradition, which, if not resolved, may lead to ineffective health promotion endeavors. Ethical traditions include normative and relativistic ethics. Relativistic theories assume that ethical rules are formed by each community and are relevant and authoritative only for people in that community, that moral rules are unnatural and obedience to them is only the result of public opinion, and that might makes right. In contrast to this relativistic position are the normative ethical theories, such as the natural law theory, which assume that principles are universal. This tradition, which originated with the Greeks and is the foundation for many mainstream religious traditions, is based on a teleology or final cause. Everything in nature has a distinct end to achieve or a function to fulfill. Aristotle thought that every art and every inquiry and similarly every action and pursuit aimed at some good, which was the special function of a thing (Stumpf, 1983). For example, apple trees have a certain nature. To have good apple trees, a person must act toward these trees in accord with their nature. The person must give them water, good soil with proper nutrients, and sunlight in order to produce good apple trees. If trees fail to produce apples, then the cultivator is doing something wrong and, if good apples are produced, something right. Humans similarly have a distinctive nature. As the proper function of an apple tree is not revealed by opinion but by analysis of the tree’s nature, appropriate human behavior is discovered by analysis of human nature. What implications does the interaction between ethical traditions have for health education practice? Usually there is agreement on what constitutes a problem despite the pluralism of American society. Differences most often occur in etiological descriptions and proposed solutions. Ethical competency is most crucial here. For example, some of the most controversial topics relate to sex and sexuality. Most people coming from various ethical traditions can agree that teen pregnancy, sexually transmitted disease