Exploring the Concept of Respect for Autonomy in the Context of New Zealand Health Promotion

Abstract

Respect for autonomy is a concept that has been centrally important to public health ethics. Existing discussions of health promotion ethics have often focused on when it is and is not okay to override autonomy. Neoliberal discourses in New Zealand health promotion policy debates suggest that the provision of information is the optimal way to protect autonomy in health promotion because this allows for the preservation of choice and freedom. This thesis explores the overall question of what it would look like to respect autonomy in health promotion policy. It is revealed that multiple characterisations of autonomy exist, both within health literature and more generally, and this complicates arguments. Drawing on a characterisation of autonomy as meaningful opportunities to pursue one’s own values, I argue that focusing on notions of choice, freedom, and the importance of information fails to respect autonomy in health promotion. Focusing on providing information assumes that health education campaigns can compete with the multitude of other forces, such as industry advertising, that aim to have people act counter to the messages of health promotion. Furthermore, corporate influence in health promotion narratives obscures informed decision-making. Even when presented with all relevant and unbiased information, people’s autonomy can still be compromised if their circumstances inhibit action on health information. Holding people responsible for deficits in health when they could not have been reasonably expected to act otherwise is ethically unacceptable. If we want to show equal regard for the autonomy of all persons, as I suggest we should, then addressing circumstances is centrally important, and information is not enough.