Should promotion of autonomy be a goal of public health?

While health care goals are usually formulated in terms of the securing of good health for the population, the goal of public health is to an increasing extent, at least in Western countries, being formulated in terms of the provision of societal preconditions for securing of good health. This goal may be attained although no one enjoys good health as a result, namely if people choose not to make use of the preconditions provided. However, reaching this goal may still seem desirable in that it promotes the autonomy of people with regard to health-related choices. In this presentation, I address the questions: 1) whether or not the promotion of autonomy may be supported as goal of public health on the basis of ethical theories dealing with autonomy, 2) whether this support is equally strong regardless of the economic, social and cultural conditions of different countries. I will argue that the first question may be answered affirmatively only if certain important revisions are made in the ethical theories in questions but that these revisions at the same time raise a number of very complicated issues in theory as well as in practice. Regarding the second question, I will claim that in so far as the goal of promoting autonomy may be morally justified, there are a number of reasons supporting the suggestion that this justification is much stronger in societal settings where reasonably high health and welfare levels are allready secured.
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