The ethics of distress: Toward a framework for determining the ethical acceptability of distressing health promotion advertising

Abstract

Distressing health promotion advertising involves the elicitation of negative emotion to increase the likelihood that health messages will stimulate audience members to adopt healthier behaviors. Irrespective of its effectiveness, distressing advertising risks harming audience members who do not consent to the intervention and are unable to withdraw from it. Further, the use of these approaches may increase the potential for unfairness or stigmatization toward those targeted, or be considered unacceptable by some sections of the public. We acknowledge and discuss these concerns, but, using the public health ethics literature as a guide, argue that distressing advertising can be ethically defensible if conditions of effectiveness, proportionality necessity, least infringement, and public accountability are satisfied. We do not take a broad view as to whether distressing advertising is ethical or unethical, because we see the evidence for both the effectiveness of distressing approaches and their potential to generate iatrogenic effects to be inconclusive. However, we believe it possible to use the current evidence base to make informed estimates of the likely consequences of specific message presentations. Messages can be pre-tested and monitored to identify and deal with potential problems. We discuss how advertisers can approach the problems of deciding on the appropriate intensity of ethical review, and evaluating prospective distressing advertising campaigns against the conditions outlined.

Sequencing the threat and recommendation components of persuasive messages differentially improves the effectiveness of high‐ and low‐distressing imagery in an anti‐alcohol message in students

“…Distressing imagery arouses public complaint (Brown & Whiting, 2014) and may be associated with harms to individuals (Hastings, Stead, & Webb, 2004). These need to be offset by clear public health benefit (Williams, 2011).…”

Introduction to the Special Section: The effectiveness of fear appeals in health promotion

“…Brown & Whiting () question whether distressing advertising can be ethically justified . While they warn that the laboratory and field evidence for distressing approaches is generally weak, they conclude that some advertising may be argued to be potentially effective on the basis of theory or precedent.…”

Building workforce capacity for ethical reflection in health promotion: a practitioner's experience

“…At the mere mention of ethics, some health promotion practitioners virtually threw their hands up in the air. This phenomenon, personally observed by the first author of this article, helped to clarify for her one of the key challenges in health promotion: in the academic literature, different frameworks offer multiple options for undertaking ethical reflection in the interests of improving practice, [17][18][19][20][21][22][23][24][25][26] but there is limited guidance for dealing with the diversity of understanding and education levels on the ground, especially in rural areas. Therefore, one of the main aims of this article is to present a framework developed to assist health promotion practitioners to engage in explicit and systematic ethical reflection with precisely this diversity in mind.…”