Medical Sales Promotion Campaigns Ethics Essay Assignment Paper

Health communications campaigns are a major strategy used by governments to promote health. This article discusses key issues in the ethics of health communications campaigns, including the compatibility of health campaigns with the principle of respect for autonomy and how conflicts with this principle can be justified. Five potential justifications for state-sponsored health communications campaigns are reviewed: the public’s health as an independent value; collective efficiency and majoritarian preferences; third party or state’s interests; harm to the health of others; and countering the short-term contingencies of a market.Medical Sales Promotion Campaigns Ethics Essay

PIP:

Health communications campaigns are a major strategy used by governments to promote health. Usually they have an explicit or implicit persuasive intent. That is, they aim to change beliefs, attitudes, or behavior. Health communications campaigns are therefore a form of persuasive communications just like advertising. This article discusses key issues in the ethics of such campaigns, including the compatibility of health campaigns with the principle of respect for autonomy and how conflicts with that principle can be justified. Five potential justifications for state-sponsored health communications campaigns are reviewed: the public’s health as an independent value, collective efficiency and majoritarian preferences, third party or state’s interests, harm to the health of others, and countering the short-term contingencies of a market.

That health is endangered, lives are lost, and illness increased as a result of poor or destructive personal habits are by now well-established facts. ¹ In the United States, as well as in other societies with advanced systems of medical care, repeated calls are made for efforts to alter or modify behavioral patterns with negative consequences for health. ² Interest in such policies stems partly from growing doubts about the ability of therapeutic medicine to solve the problems posed by the current pattern of morbidity and mortality. ³ The interest also stems from the realization that an upper limit may have been reached in the willingness of the citizenry to shoulder the burden of an expanding health care sector that now consumes close to 11 percent of the gross national product. But whatever the sources of the interest in the modification of personal habits and behaviors that affect the health of men and women, it is clear that many now believe that something must be done.Medical Sales Promotion Campaigns Ethics Essay

Despite the popularity of this perspective, there is considerable doubt and confusion as to the appropriate course of action. Who has the right to modify whose behavior and under what circumstances? What should the role of government be in promoting or mandating those behaviors that presumably produce good health, and in discouraging or forbidding those behaviors that presumably produce illness and lead to early death? Issues in this arena raise difficult questions about the appropriate relationship between the individual and the state. We are compelled to deal in a concrete fashion with the conflict between liberty and paternalism, between personal preference and social welfare. We must address complex issues regarding the relationships between coercion and incentives, between education and manipulation.

How may the state justify the control of personal behavior that appears, at first, to affect only the individual? To what extent do individuals have the right to behave foolishly and self-destructively? Can state action only be justified by arguing that self-destructive behavior is not truly voluntary (the product of coercive factors —either psychological or social), and that state intervention thus represents a restoration of “true” autonomy? When an individual argues that he or she has freely chosen to engage in certain behaviors despite the possibility of disease and premature death, can the state legitimately attempt to behave paternalistic ally? ⁴

It is of course possible to argue that though the individuals who engage in hazardous behaviors suffer the primary consequences themselves, society must bear the cost of such “self-regarding” acts. Because of the tendency to place greater and greater obligations on society for the provision of health care through third-party mechanisms, the burden has increasingly become communal and not just individual. Additionally, because morbidity and mortality affect the general well-being of society in terms of its productive capacity, such behavior produces a social impact. ⁵ To the extent that these arguments are accepted, the realm of individual action will become harder to distinguish from that of social action. Self-regarding behavior will cease to exist, and the claims of liberty will increasingly be subordinated to those of community. To what degree should the imperatives of health be permitted to provide the justification for so fundamental a change in our deepest ethical and political commitments? Should the ideal of health provide the warrant for such a transformation when other social goods do not?

This paper sets out the ethical principles that ought to guide policymakers as they attempt to fashion government policy regarding personal behavior and health. Secondly, the paper examines the ethical issues that must be confronted as alternative strategies to affect personal behavior are considered and applies this set of ethical considerations to three critical cases.Medical Sales Promotion Campaigns Ethics Essay

Though it is clear that virtually every dimension of personal behavior can contribute to the onset of disease or to its prevention, we have chosen to limit our discussion to cigarette smoking, alcohol consumption, and vehicular behavior. Though limiting discussion of policy interventions to these activities that occur in public or which can be controlled through the regulation of commerce may appear to be a timid gesture, to include changes in the patterns of exercise, diet, and sleep along with these more public forms of behavior conjures up images of profound invasions of privacy, scarcely tolerable in a liberal society. In fact, it is the precondition for a serious discussion of whether government should seek to modify personal behaviors linked to disease and untimely death.

Personal Behavior And Health

If a single event could be pinpointed as representing the commencement of the public and official discussion of the role of government in health promotion, it would be the publication in 1975 of “A New Perspective on the Health of Canadians.” In that report Marc Lalonde, the Minister of National Health and Welfare, bluntly stated: “Self-imposed risks and the environment are the principal or important underlying factors in each of the five major causes of death between ages one and seventy, and one can only conclude that unless the environment is changed and the self-imposed risks are reduced, the death rates will not be significantly reduced.”

But even the pursuit of health had to be bounded by other considerations especially when matters of liberty and privacy were at stake. Lalonde not only recognized the risks involved, but was alert to the nature of the opposition his challenge could well provoke: “The ultimate philosophical issue… is whether and to what extent government can get into the business of modifying human behavior, even if it does so to improve health.” ^{7Medical Sales Promotion Campaigns Ethics Essay}

Involved were not only issues that would arise in the course of direct efforts at restriction and prohibition, but those that would surface if the government took on the function of “marketing ideas.” These themes found expression two years later in the United States in the widely read and cited essay by John Knowles, “The Responsibility of the Individual,” that appeared as part of the Daedalus symposium, “Doing Better and Feeling Worse: Health in the United States.” Though he noted the extent to which environmental and socioeconomic factors contributed to behavior with disastrous consequences for health, it was his striking comments on personal responsibility for morbidity that were to provoke a lively and important debate. For Knowles, the social consequences of individual behavior in terms of the cost of medical intervention could no longer be tolerated: “The costs of individual irresponsibility in health have now become prohibitive. The choice is individual responsibility or social failure. Responsibility and duty must gain some degree of parity with right and freedom.”

The untoward social consequences of individual behavior were to become the leitmotiv of the American debate over health, life-styles, and government responsibility. It clearly was central for Department of Health and Human Services Secretary Joseph Califano in his introduction to Healthy People. “Indulgence in private excess,” wrote Califano, “has results that are far from private. Public expenditures for health care are only one of the results.”  While acknowledging that there might well be controversy and debate about the appropriate role of government in urging citizens to give up their “pleasurable but harmful habits,” Califano argued that “there could be no denying the public consequences of these private acts.”

Ethical Issues At The Threshold: Autonomy, Equity, And Community

From an ethical perspective, the determination of whether government should regulate the behavior of individuals in the name of health requires that policymakers go beyond the questions of efficiency and political acceptability. What moral warrant is there for such intervention? Does such a warrant also impose an obligation on the part of government to intercede? The demands of autonomy, equity, and community are central to any attempt to fashion an ethically sensitive public policy in this domain.

Autonomy.

No issue has received more attention in the public and professional discussions of the appropriateness of government policy designed to affect personal behavior in the name of health than that of autonomy. Reflecting the profound influence of liberalism in American social thought, any attempt by the state to affect behavior that is conceived of as self-regarding is viewed with great suspicion.Medical Sales Promotion Campaigns Ethics Essay

The realm of privacy is held to be inviolate, except for those occasions when it can be demonstrated that what initially appears to be self-regarding is in fact behavior with demonstrable and marked consequences for others, or when it can be demonstrated that what appears to be the decision of a competent adult acting under his or her own volition is in fact the consequence of some powerful, dominating, or coercive force. Given this commitment to individual autonomy, state actions directed at individuals in the name of their own health —paternalistic actions —are difficult to justify. Though there is, in fact, a broad range of extant regulatory provisions that are demonstrably paternalistic, each contemporary effort to overcome the predilection for autonomy must show that apparently voluntary behavior is the product of misinformation or the result of an irresistible compulsion. The goal of justifiable paternalism is to protect the individual from the consequences of actions that he or she would not choose to engage in were the capacity for free choice truly present.

Though it would be theoretically possible to argue that many forms of personal behavior that produce ill health are undertaken only because the individual does not fully appreciate the ultimate consequences of such behavior, this would be a difficult proposition to defend today. Given the widespread dissemination of public health information regarding smoking, alcohol consumption, and reckless vehicular behavior, it would be necessary to argue that individuals cannot appreciate the consequences of behaviors that produce their effects in the (personally) remote future, or that the statistical risk to any individual is so small that it is not possible to make personal decisions incorporating such information.

The difficulty that attends efforts to provide the justifications of paternalism has made such arguments largely unattractive to those seeking a moral foundation for regulatory policies put forth in the name of health. As an alternative, advocates of government intervention have sought to demonstrate that the consequences of personal behavior are social burdens that warrant public action. Thus shifting the grounds of discussion obviates the necessity of putting forth arguments to demonstrate that the individual must be protected from his own ill-conceived actions. Instead, since the burden generated by personal behavior causing ill health must be assumed by others, it has been argued that an issue of equity is involved.Medical Sales Promotion Campaigns Ethics Essay

Equity.

The discovery of the social impact of personal behavior on morbidity and mortality has provided the foundation for public discussions of the appropriate scope of governmental activity. Both the Lalonde Report and Healthy People provide ample evidence of this fact.

Invariably such discussions are based upon economic analyses of the externalizes associated with personal behavior. The cost of health care and of health insurance, the burden of social security payments to those who are disabled, the necessity of providing social supports to families deprived of primary wage earners, the toll of reduced productivity, these are typically the costs traced back to the “private” acts of those who engage in behavior that produces disease and untimely death.

What from the point of view of economics is a negative externality requiring efforts at internalization of costs, from the vantage point of ethics becomes a matter of distributive justice. What does equity demand in terms of the burdens generated by the costs of behaviorally induced ill health? Why should nonsmokers be forced to bear the burden of smokers’ behavior? Why should nondrivers or drivers who do wear seat belts be required to bear the burdens of those who refuse to do so? Equity, some have argued, demands that those who choose to smoke, or to drive without seat belts be forced to bear the economic consequences of their own behavior. In those instances where no mechanism exists to internalize the costs of behavior, equity might necessitate the application of disincentives, and even prohibitions of the behavior itself.

The focus on the social costs of personal behavior seems to suggest that if it were possible to avoid the problem of negative externalities by internalizing such costs, there would be little justification for social intervention, for tolerating government intrusion. But does the characterization of the problem of morbidity and mortality associated with personal behavior in terms of economic costs alone adequately capture the extent of our moral intuitions? Limiting the costs of smoking (including death from lung cancer) to smokers themselves, or limiting the cost of neurosurgery to the unbelted victims of automobile accidents, cannot be viewed as a satisfactory moral solution.Medical Sales Promotion Campaigns Ethics Essay

The contemporary stress upon quantifiable economic social costs of personal behavior presses upon us a conception of public concern for health that begins and ends with an accountant’s ledger and which is in fact at variance with the desire to prevent untimely death, suffering, and illness as ends in themselves. A reading of court cases in this area — especially those associated with motorcycle helmet laws—reveals a strained quality in the argumentation. While data on social costs are mobilized in defense of state regulation, another set of motivations is clearly involved. The acceptable public rationale appears to be at odds with the unspoken, perhaps unspeakable, commitment to health and well-being of individuals and the community.