{"id":2292,"date":"2020-06-19T19:10:55","date_gmt":"2020-06-19T19:10:55","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmjsrh\/?p=2292"},"modified":"2020-06-19T19:10:55","modified_gmt":"2020-06-19T19:10:55","slug":"larc-ethics","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmjsrh\/2020\/06\/19\/larc-ethics\/","title":{"rendered":"The ethics of State-sponsored and clinical promotion of long-acting reversible contraception"},"content":{"rendered":"

By Dr Jeffrey Wale & Professor Sam Rowlands, Bournemouth University<\/a><\/em><\/p>\n

@rowlands999\u00a0<\/a> @bournemouthuni<\/a><\/p>\n

Global responses to the Covid-19 pandemic offer a good opportunity to re-examine the role of State actors (policymakers, regulatory bodies, clinical commissioning groups, service providers) and healthcare professionals in the promotion of health-related behaviours.\u00a0 Just how far should healthcare professionals go in promoting, persuading, and influencing \u2018good\u2019 behaviours in the patient encounter?\u00a0 Who decides what is \u2018good\u2019 and how far should resource considerations shape the informational exchange process and the recommendations made to individual patients?<\/p>\n

Our article uses long-acting reversible contraception (LARC) as the fulcrum to address these issues.\u00a0 There has been a tendency for the public and clinical narrative to emphasise the simplicity and long-term duration of effect, and to treat LARC as an unqualified good for all.\u00a0 Sure, LARC provides a valuable and effective contraceptive option for many users, but some individuals do experience difficulties during and after use.\u00a0 Low risk does not equate with no risk; and effectiveness may be less valuable than immediate control for some users. The positives of LARC methods are often seized upon<\/a> in jurisdictions keen to promote efficacious and reliable contraceptive options for their population. There has also been a tendency to discuss LARC as a singular unified option, when the reality is a diverse range of methods that work upon the human body in different ways.\u00a0 This can have ramifications for the resulting discourse.<\/p>\n

In terms of the State promotion of LARC methods, there are two central concerns.\u00a0 What reasons or motives underpin the active promotion of any specific contraceptive option?\u00a0 In many ways, it is easier to identify \u2018bad\u2019 motives that count against promotion.\u00a0 We know that LARC methods can be promoted to vulnerable demographic groups<\/a> without due regard for individual circumstances, values or wishes.\u00a0 Discriminatory targeting is likely to be problematic, if user autonomy is recognised and valued to any real extent.\u00a0 Second, we should be concerned by the degree to which State actors are honest, transparent, and consistent in any public narrative about LARC use and promotion.\u00a0 Is the central message one of respect for user autonomy or responsible family spacing or parenting? The normative messaging behind responsible parenting, implicitly prioritises impersonal and consequential considerations over the enhancement of individual choice.\u00a0 Here the emphasis is on societal obligations and consequences, rather than the importance of individual values and priorities.<\/p>\n

At a local level, healthcare professionals are often placed in an invidious position.\u00a0 On one side, there may be pressure at an organisational or executive level to promote certain behaviours in their patient or user populations.\u00a0 On the other, they will owe distinct professional obligations to potential and existing users.\u00a0 Here the relationship is of a different kind.\u00a0\u00a0 State actors have an anonymous and remote relationship with the end user.\u00a0 Healthcare professionals ought to and are likely to have a much closer and trust laden relationship<\/a> with an identifiable individual. We argue that imposing a dual responsibility upon healthcare professionals for raising awareness\/ informational exchange and the active promotion of LARC, creates an unnecessary tension and barrier for the delivery of patient-centred care.\u00a0 It is paramount that healthcare professionals acknowledge this and do not make the questionable assumption that every user will be influenced solely by the relative effectiveness of any given contraceptive method.\u00a0 Ultimately, what matters is a balanced narrative and information sharing programme that respects the individual interests and priorities of each contraceptive user.<\/p>\n

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Read the full paper here<\/a><\/p>\n

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Wale<\/span>\u00a0J<\/span>,\u00a0Rowlands<\/span> S.\u00a0<\/span><\/span>The ethics of state-sponsored and clinical promotion of long-acting reversible contraception. BMJ Sexual & Reproductive Health\u00a0<\/span>Published Online First:<\/span>\u00a016 June 2020.\u00a0<\/span>doi:<\/span>\u00a010.1136\/bmjsrh-2020-200630<\/span><\/div>\n<\/div>\n<\/div>\n<\/dd>\n<\/dl>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n
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By Dr Jeffrey Wale & Professor Sam Rowlands, Bournemouth University @rowlands999\u00a0 @bournemouthuni Global responses to the Covid-19 pandemic offer a good opportunity to re-examine the role of State actors (policymakers, regulatory bodies, clinical commissioning groups, service providers) and healthcare professionals in the promotion of health-related behaviours.\u00a0 Just how far should healthcare professionals go in promoting, […]<\/p>\n

Read More…<\/a><\/p>\n","protected":false},"author":364,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[599],"tags":[],"class_list":["post-2292","post","type-post","status-publish","format-standard","hentry","category-screening"],"yoast_head":"\nThe ethics of State-sponsored and clinical promotion of long-acting reversible contraception - BMJ Sexual & Reproductive Health blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmjsrh\/2020\/06\/19\/larc-ethics\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"The ethics of State-sponsored and clinical promotion of long-acting reversible contraception - BMJ Sexual & Reproductive Health blog\" \/>\n<meta property=\"og:description\" content=\"By Dr Jeffrey Wale & Professor Sam Rowlands, Bournemouth University @rowlands999\u00a0 @bournemouthuni Global responses to the Covid-19 pandemic offer a good opportunity to re-examine the role of State actors (policymakers, regulatory bodies, clinical commissioning groups, service providers) and healthcare professionals in the promotion of health-related behaviours.\u00a0 Just how far should healthcare professionals go in promoting, [...]Read More...\" \/>\n<meta property=\"og:url\" content=\"https:\/\/blogs.bmj.com\/bmjsrh\/2020\/06\/19\/larc-ethics\/\" \/>\n<meta property=\"og:site_name\" content=\"BMJ Sexual & Reproductive Health blog\" \/>\n<meta property=\"article:published_time\" content=\"2020-06-19T19:10:55+00:00\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"3 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmjsrh\\\/2020\\\/06\\\/19\\\/larc-ethics\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmjsrh\\\/2020\\\/06\\\/19\\\/larc-ethics\\\/\"},\"author\":{\"name\":\"\",\"@id\":\"\"},\"headline\":\"The ethics of State-sponsored and clinical promotion of long-acting reversible contraception\",\"datePublished\":\"2020-06-19T19:10:55+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmjsrh\\\/2020\\\/06\\\/19\\\/larc-ethics\\\/\"},\"wordCount\":613,\"commentCount\":0,\"publisher\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmjsrh\\\/#organization\"},\"articleSection\":[\"screening\"],\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\\\/\\\/blogs.bmj.com\\\/bmjsrh\\\/2020\\\/06\\\/19\\\/larc-ethics\\\/#respond\"]}]},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmjsrh\\\/2020\\\/06\\\/19\\\/larc-ethics\\\/\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/bmjsrh\\\/2020\\\/06\\\/19\\\/larc-ethics\\\/\",\"name\":\"The ethics of State-sponsored and clinical promotion of long-acting reversible contraception - 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