HELPING PEOPLE CHANGE - AN ETHICAL APPROACH

This paper is a normative analysis of an empowerment approach in healt h promotion. In particular it utilizes two increasingly influential id ioms of normative analysis (analytic health care ethics and Foucauldia n analysis) to evaluate the ethics of 'helping people change'. The HEA pack entitled 'Helping People Change' (HPC) is used as an exemplary c ase study and as a starting point for analysis; but the implications a re intended to be more wide ranging and the purpose of the analysis is two-fold. First, ethical discussion is presented as an important dime nsion of the substantive evaluation of HPC-type interventions (i.e. in terventions which emphasize support for voluntary change). Second, it is presented as a means of comparing and contrasting the role of the t wo normative idioms in such ethical evaluation. The aims and the under lying rationale of the HPC pack are set out. Analytic health care ethi cs is represented by the well-known 'four principles' approach and the longest section of the paper applies each of these principles in turn (beneficence, non-maleficence, autonomy and justice) to the HPC pack. It is argued that for each principle there are ethical difficulties a ttaching to HPC-type interventions. This is (albeit superficially) par adoxical given that such interventions are arguably exemplary and are self-consciously 'ethical'. It is here that a Foucauldian perspective presents a sharp contrast. According to such a perspective, it is argu ed, the idea of helping people change is 'obviously' questionable. Thi s is because Foucauldian analysis centres around the intimate links be tween empowerment, control and 'the creation of subjects'. Finally, so me of the other contrasts between, and the potential complementarity o f, the two normative perspectives are briefly reviewed.