Helping people change—an ethical approach?

This paper is a normative analysis of an empowerment approach in health promotion. In particular it utilizes two increasingly influential idioms of normative analysis (analytic health care ethics and Foucauldian analysis) to evaluate the ethics of ‘helping people change’. The HEA pack entitled ‘Helping People Change’ (HPC) is used as an exemplary case study and as a starting point for analysis; but the implications are intended to be more wide ranging and the purpose of the analysis is two-fold. First, ethical discussion is presented as an important dimension of the substantive evaluation of HPC-type interventions (i.e. interventions which emphasize support for voluntary change). Second, it is presented as a means of comparing and contrasting the role of the two normative idioms in such ethical evaluation. The aims and the underlying rationale of the HPC pack are set out. Analytic health care ethics 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 attaching to HPC-type interventions. This is (albeit superficially) paradoxical 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 argued, the idea of helping people change is ‘obviously’ questionable. This is because Foucauldian analysis centres around the intimate links between empowerment, control and ‘the creation of subjects’. Finally, some of the other contrasts between, and the potential complementarity of, the two normative perspectives are briefly reviewed.