Ethical Dimension of Stigmatization in Public Health: Decision Support Tool - 2018 Update
- Health-related stigmatization is a social process that involves the formation or reinforcement of negative social representations of certain groups of individuals, who are labelled based on health problems considered preventable or within their control.
- Behaviours, lifestyles, living conditions or other personal characteristics are attached to a moral evaluation which designates “good” or “bad” diseases, and “good” or “bad” patients. These persons are considered responsible and blamed for the risk to their health and, if applicable, for the risk to which they expose other persons. Persons so targeted suffer damage to their identity which, in extreme cases, is reduced to the health problem or characteristic. Whether real, anticipated, or perceived, stigmatization vilifies individuals and groups; it results in or worsens their social disqualification.
- The consequences of damaged identity and social disqualification vary in terms of form and intensity. For example, they may affect a person’s self-representation (loss of self-esteem), increase vulnerability to health problems, limit access to care and services or result in unjustified, different treatment (workplace or housing discrimination, etc.).
- Ethical reflection about stigmatization generally answers the question: “To what extent, and under what conditions, can public health activities be ethically justified when they are associated with stigmatization or or when do they risk reinforcing it?”
- Thus, the ethical dimensions of stigmatization relate to, each in turn, personal responsibility and autonomy, respect for dignity and non-maleficence, harm to others, equity and beneficence. The relationship between these dimensions will be clarified using a tool available in the Annex, which will foster reflection on public health actions that might directly or indirectly cause stigmatization. The tool enables identification of the values at issue and, when there is tension between them, identifies the values that take precedence in a given situation through an arbitration process. The solution chosen should reflect the precedence of values and an activity will be considered justifiable or reasonable to the extent that it is compatible with the value identified as the most important.
