Bringing ethical thinking to social change initiatives: Why it matters.

Norms-shifting interventions (NSI) seek to improve people's well-being by facilitating the transformation of harmful social norms, the shared rules of acceptable actions in a group that prop up harmful health behaviours. Community-based NSI aim for incremental normative change and complement other social and behaviour change strategies, addressing gender, other inequalities, and the power structures that hold inequalities in place. Consequently, they demand that designers and implementers-many who are outsiders-grapple with power, history, and community agency operating in complicated social contexts. Ethical questions include whose voices and values, at which levels, should inform intervention design; who should be accountable for managing resistance that arises during implementation? As interest and funding for NSI increases in lower and middle-income countries, their potential to yield sustained change is balanced by unintentionally reinforcing inequities that violate human rights and social justice pillars guiding health promotion efforts. A review of 125 articles on ethical considerations in public health, social justice, and human rights-where NSI actions intersect-indicated little guidance on practice. To begin to address this gap, we propose ten ethical values and practical ways to engage ethically with the social complexities of NSI and the social change they seek, and a way forward.

Anthropological contributions for thinking and acting in the health area and its ethical dilemas

This paper attempts to analyze the way in which the issue of ethics in social research is dealt by institutional commissions based in biomedicine criteria. This discussion is particularly important for Social Sciences in Health, as our projects must necessarily be presented to Committees for assessment. In actual fact, Resolution Nº 196/1996 issued by the National Health Council establishes this mandatory requirement for all social areas. However, there is a question among researchers working with social issues, arguing that the health sector is moving outside its field when attempting to regulate actions in other fields of investigation. Grounded on philosophical anthropology, this paper is divided into three parts: (1) elements of anthropological foundations of ethics; (2) contributions of Anthropology to thinking about ethics and human rights in health; (3) internal and external questioning about anthropological practice. I conclude that if the ethical issue that involves human beings cannot be reduced to the procedures established by Ethics Committees, discussions in greater depth are required among social scientists on the construction of a practice based on and guided by respect for the intersubjectivity of all the players engaged in a research project.

Neste artigo, busco problematizar a forma como a questão da ética em pesquisa social vem sendo tratada hoje pelas comissões institucionais inspiradas nas questões da biomedicina. Essa discussão é particularmente importante para as Ciências Sociais em Saúde pois existe uma obrigatoriedade de apresentação dos nossos projetos para avaliação dos comitês. A rigor, na concepção da Resolução 196/1996 do Conselho Nacional de Saúde, essa obrigatoriedade cobre todas as áreas sociais. No entanto, existe questionamento dos pesquisadores que lidam com o social, argumentando que o setor saúde extrapola quando tenta regular ações de outros campos de investigação. Fundamentado na antropologia filosófica, este texto se divide em três partes: (1) alguns elementos sobre fundamentos antropológicos da ética; (2) contribuições da Antropologia para pensar a ética e a realização dos direitos humanos em saúde; (3) questionamentos internos e externos sobre a prática antropológica. Concluo dizendo que, se a questão ética que envolve seres humanos não pode se reduzir aos procedimentos demandados por Comissões de Ética, é preciso aprofundar a discussão dos cientistas sociais na construção de uma prática pautada e orientada pelo respeito à intersubjetividade de todos os atores envolvidos numa pesquisa.

A feminist challenge to practices of medicine.

Susan Sherwin's No Longer Patient: Feminist Ethics and Health Care is a readable book that is accessible to a wide range of medical practitioners. It presupposes no prior training in ethics or feminism (and for just this reason, it may be somewhat less satisfying, although not necessarily less useful, for philosophers). The book is a feminist bioethics primer that introduces medical practitioners to issues that feminist theory makes prominent and that illuminate tensions in the structure and practice of medicine.