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<h3 align="JUSTIFY"><font face="book antiqua, times new roman, times" color="#996600" mstheme>Introduction</font></h3>
<p align="JUSTIFY">The World Health Organisation defines health promotion as;</p>
<p align="JUSTIFY"><em>‘....the process of enabling people to increase control over
and to improve their health’. </em></p>
<p align="JUSTIFY">Strategies and methods employed to promote sexual health need to be
respectful of the complex determinants of health i.e. Socio-political, psychological,
spiritual, cultural factors. Sexual Health promotion cannot ignore the interplay of
ethical, moral and legal implications for both the professional and their clients. Some
definitions of terms may be helpful;</p>
<h5 align="JUSTIFY"><font face="book antiqua, times new roman, times" color="#660033" mstheme><big>Morals</big>: The domain of personal values and rules of
behaviour. Rules of conduct regulating our social interactions. Culture specific mores,
grounded in religion/ideology.</font></h5>
<h5 align="JUSTIFY"><font face="book antiqua, times new roman, times" color="#660033" mstheme><big>Ethics</big>: The collective belief and value system of any moral
community, social or professional group. It is the science of morals involving applying
moral principals to practical situations </font></h5>
<h5 align="JUSTIFY"><font face="book antiqua, times new roman, times" color="#660033" mstheme><big>Problems</big>: Difficult matters requiring solution</font></h5>
<h5 align="JUSTIFY"><font face="book antiqua, times new roman, times" color="#660033" mstheme><big>Dilemmas</big>: Choices needed between undesirable alternatives</font></h5>
<h5 align="JUSTIFY"><font face="book antiqua, times new roman, times" color="#660033" mstheme><big>Quandaries</big>: Perplexed states of practical uncertainty over
alternative choices.</font></h5>
<p align="JUSTIFY">All of the above abound in our work. The pluralistic society within
which we live means that the variety of cultures and lifestyles that exist simply serve to
create tensions and conflicts when seeking to legislate for sexual behaviour. The picture
is constantly changing too as values and attitudes are moulded and refined. Our work may
put us in contact with the full range of human diversity and whereas a non-judgemental
attitude is essential this is not easily achieved. If stereotyping of clients is to be
avoided the concept of sexual diversity needs to be fully embraced. Acceptance of others
will be easier when we ourselves have an acceptance of our own sexuality and an
appreciation of how it has been shaped by biological, psychological, social and spiritual
factors (Curtis, 1995).</p>
<h3 align="JUSTIFY"><font face="book antiqua, times new roman, times" color="#996600" mstheme>Some ethical issues commonly raised in sexual health promotion</font></h3>
</font><table border="0" cellpadding="0" cellspacing="0" width="100%" msthemelist>
<tr msthemelist><td valign="baseline" width="42"></td><td valign="top" width="100%"><font face="verdana, arial, helvetica" mstheme>Raising issues that the client has not explicitly asked to be addressed </font></td></tr>
<tr msthemelist><td valign="baseline" width="42"></td><td valign="top" width="100%"><font face="verdana, arial, helvetica" mstheme>Sex talk is ‘taboo’ and some behaviours may be distressing to discuss</font></td></tr>
<tr msthemelist><td valign="baseline" width="42"></td><td valign="top" width="100%"><font face="verdana, arial, helvetica" mstheme>Sexually transmitted infections when faced can open a ‘can of worms’.</font></td></tr>
<tr msthemelist><td valign="baseline" width="42"></td><td valign="top" width="100%"><font face="verdana, arial, helvetica" mstheme>Under-age sex is common and needs careful handling</font></td></tr>
<tr msthemelist><td valign="baseline" width="42"></td><td valign="top" width="100%"><font face="verdana, arial, helvetica" mstheme><p align="JUSTIFY">HIV is commonly surrounded by fear, ignorance and discrimination</p>
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<h3 align="JUSTIFY"><font face="book antiqua, times new roman, times" color="#996600" mstheme>So where does this leave us?</font></h3>
<p align="JUSTIFY">All of this can seem a little scary especially if working in the health
Service in general or the GUM clinic in particular with all the potential for major upset.
It is important we do not ignore legal implications though at the same time it is worth
reflecting on the fact that very few practitioners will fall foul of the law. The moral
and ethical dilemmas can cause anxiety especially when our intervention may be challenged
by others. For example how do we respond when sex education in school is thought by some
to just condone illicit sex? How directive should our advice be when helping someone make
a decision about a termination of pregnancy? Should people be given the facts and left to
decide for themselves? Should we be actively trying to change attitudes and lifestyles?
Ewles and Simnet (1995) pose the following helpful set of questions to examine if faced
with ethical dilemmas:</p>
<h4><font face="book antiqua, times new roman, times" mstheme>Questions fundamental to decisions about health. </font></h4>
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<tr msthemelist><td valign="baseline" width="42"></td><td valign="top" width="100%"><font face="verdana, arial, helvetica" mstheme>Will I be creating harmony in clients, enabling them to choose freely for themselves,
directing their own lives? </font></td></tr>
<tr msthemelist><td valign="baseline" width="42"></td><td valign="top" width="100%"><font face="verdana, arial, helvetica" mstheme>Will I respect their autonomy even if I disapprove of their actions? </font></td></tr>
<tr msthemelist><td valign="baseline" width="42"></td><td valign="top" width="100%"><font face="verdana, arial, helvetica" mstheme>Will I respect all people equally, without discrimination. </font></td></tr>
<tr msthemelist><td valign="baseline" width="42"></td><td valign="top" width="100%"><font face="verdana, arial, helvetica" mstheme>Will I be serving basic needs before any other wants?</font></td></tr>
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<h4><font face="book antiqua, times new roman, times" mstheme>Questions about duties and principles</font></h4>
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<tr msthemelist><td valign="baseline" width="42"></td><td valign="top" width="100%"><font face="verdana, arial, helvetica" mstheme>Will I be doing good and preventing harm?</font></td></tr>
<tr msthemelist><td valign="baseline" width="42"></td><td valign="top" width="100%"><font face="verdana, arial, helvetica" mstheme>Will I be telling the truth?</font></td></tr>
<tr msthemelist><td valign="baseline" width="42"></td><td valign="top" width="100%"><font face="verdana, arial, helvetica" mstheme>Will I be minimising harm in the long term?</font></td></tr>
<tr msthemelist><td valign="baseline" width="42"></td><td valign="top" width="100%"><font face="verdana, arial, helvetica" mstheme>Will I be honouring promises and agreements?</font></td></tr>
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<h4><font face="book antiqua, times new roman, times" mstheme>Questions about consequences</font></h4>
</font><table border="0" cellpadding="0" cellspacing="0" width="100%" msthemelist>
<tr msthemelist><td valign="baseline" width="42"></td><td valign="top" width="100%"><font face="verdana, arial, helvetica" mstheme>Will I be increasing individual good?</font></td></tr>
<tr msthemelist><td valign="baseline" width="42"></td><td valign="top" width="100%"><font face="verdana, arial, helvetica" mstheme>Will I be acting for the good of myself?</font></td></tr>
<tr msthemelist><td valign="baseline" width="42"></td><td valign="top" width="100%"><font face="verdana, arial, helvetica" mstheme>Will I be increasing the good of a particular group?</font></td></tr>
<tr msthemelist><td valign="baseline" width="42"></td><td valign="top" width="100%"><font face="verdana, arial, helvetica" mstheme>Will I be increasing the social good?</font></td></tr>
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<h4><font face="book antiqua, times new roman, times" mstheme>Questions about external considerations?</font></h4>
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<tr msthemelist><td valign="baseline" width="42"></td><td valign="top" width="100%"><font face="verdana, arial, helvetica" mstheme>What is the most effective and efficient thing to do?</font></td></tr>
<tr msthemelist><td valign="baseline" width="42"></td><td valign="top" width="100%"><font face="verdana, arial, helvetica" mstheme>What is the degree of risk involved?</font></td></tr>
<tr msthemelist><td valign="baseline" width="42"></td><td valign="top" width="100%"><font face="verdana, arial, helvetica" mstheme>Is there a professional code of practice which has a bearing on this?</font></td></tr>
<tr msthemelist><td valign="baseline" width="42"></td><td valign="top" width="100%"><font face="verdana, arial, helvetica" mstheme>Have I got the facts right?</font></td></tr>
<tr msthemelist><td valign="baseline" width="42"></td><td valign="top" width="100%"><font face="verdana, arial, helvetica" mstheme>Are their legal implications and if so do I understand them?</font></td></tr>
<tr msthemelist><td valign="baseline" width="42"></td><td valign="top" width="100%"><font face="verdana, arial, helvetica" mstheme>What are the views and wishes of relevant other people?</font></td></tr>
<tr msthemelist><td valign="baseline" width="42"></td><td valign="top" width="100%"><font face="verdana, arial, helvetica" mstheme>Can I justify my actions in terms of the evidence before me?</font></td></tr>
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<h3 align="JUSTIFY"><font face="book antiqua, times new roman, times" color="#996600" mstheme>Conclusion</font></h3>
<p align="JUSTIFY">It is imperative that promoting sexual health is seen as an activity
that has legal and ethical implications. The competent practitioner is a reflective one.
There will always be a measure of risk taking and if calculated correctly should reap
dividends with a professional approach. When it comes to promoting sex many individuals
see the need for it but few are confident to embrace it as an integral part of their role.
Training opportunities exist to better equip professionals to meet the challenge of
promoting a healthier sex life for their clients. Supervision is also of vital importance
if we are to get the support needed to continue the juggling act our roles often demand. </p>
<h3 align="JUSTIFY"><font face="book antiqua, times new roman, times" color="#996600" mstheme>Further reading</font></h3>
<p align="JUSTIFY">Burr, M. (1982) The Law and Health Visitors. Edsall and Co.</p>
<p align="JUSTIFY">Curtis, H. (1995) Sexual Health Promotion in General Practice.
Radcliffe Press.</p>
<p align="JUSTIFY">Edwards, S.D. (1996) Nursing Ethics – a Principle Based Approach.
Macmillan.</p>
<p align="JUSTIFY">Ewles, L and Simnett, I. (1995) Promoting Health: A practical Guide.
3rd Edition. Scutari Press</p>
<p align="JUSTIFY">Montgomery, J. (1997) Health Care Law. Oxford University Press</p>
<p align="JUSTIFY">Samuels, A. (1993) The Legal Liability of the Nurse - the lawyer’s
view. Med.Sci.Law. 33(4)</p>
<p align="JUSTIFY">Thompson, I., Melia, K., and Boyd, K. (1994) Nursing Ethics. Churchill
Livingstone. </p>
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