Ethical Health:
Time to Add a New (Old) Dimension to our Wellness Wheels

Joel Bennett, learn@organizationalwellness.com
 
Many models of health and wellness envelop domains through which people achieve well-being. This includes physical, emotional, social, intellectual, occupational (work), financial, and spiritual, among others. With many models out there, I have yet to find one that includes the domain of ethical health. For now, by ethical health, at the very least, I mean the well-being that ensues when we follow two principles.

These two enduring principles or maxims can (or should) inform how we treat each other as human beings. First, the Golden Rule:

I shall treat other people with the same respect I wish to be treated.

Second, a key phrase from the Hippocratic Oath that medical and other health practitioners abide by:

I will abstain from all intentional wrong-doing and harm.

Together, these two principles speak to such values as humanity, life, kindness, love, care, benevolence, cooperation, unity, altruism, community, friendship, generosity, brotherhood, sisterhood, self-transcendence, etc. In our reaction to polarized opinions, abuse, stress and fear, human beings will behave in ways that do not align with these values.

Examples of values that often compete with the Golden Rule and the Hippocratic Oath include competition, conformity, power, hedonism, nationalism, self-determination, individualism, achievement, materialism, dogma, etc. The study of sociology, religion, politics, and cults are replete with examples where one’s social group (affiliation, tribe, nation, political party) dictates the values that one upholds. This is most clearly seen in how people behave during times of stress, when their security is threatened, or when under attack.

BUT WHAT IS (NOT) ETHICAL HEALTH?

This brief article cannot do justice to the immense amount of scholarship surrounding the idea that joy, happiness, and well-being exists within oneself and others as a result of fulfilling social and ethical obligations, doing moral good, and acting as a decent human being and with responsibility toward and for others. Simone Weil, in her 1949 book “The Need for Roots” claims that our most fundamental obligation requires that we all respect the essential needs of others - the "needs of the soul".  

We need to turn to these positive aspects of morality and ethics. Those of us working in the fields of wellness, well-being, and health promotion need to show how moral virtues such as friendship, honor, service, duty, and care improve all other dimensions of health, from the physical to the spiritual.

Unfortunately, much of the scholarship and focus does not follow Weil’s guidance, or many others writing in a similar vein, like Erich Fromm, Tielhard De Chardin, Scott Peck, Lawrence Kohlberg, Emmanuel Levinas, Amélie Rorty, Martin Buber, or Simone DeBeauvoir. Instead, we tend to see more on ethical disease. Here are some examples of this undue focus on the negative aspects of ethical health.

The construct of “moral distress” has been studied in the field of nursing, with self-report measures (e.g., Corley et al., 2008) asking whether nurses feel stress when they experience any number of moral breaches at work. This includes policies lacking in full respect of patients, doctors not acting on behalf of patient’s best interests, nurses abusing patients, and other nurses ignoring such abuse. It also includes feeling distress due to competing values, such as following family wishes for the patient that the nurse disagrees with.

Parallel stressors occur in the professional field of health promotion. In recent years, within workplace wellness, there has been great concern that both obtaining biometric data from employees and incentivizing or providing penalties for doing so is unethical. The overt focus on proving return-on-investment and not doing wellness because “it is the right thing to do” has been an ongoing stress for workplace wellness professionals. Wellness coaches or nutritionists can also struggle when they have clients who buy-in to the latest and sub-par diet craze or when clients share information that go against one’s own set of values.

Other examples. Recent growth in discussions of “moral injury” in healthcare or struggles with who we serve: the patient, the client, the employer, or the insurance agency. In the age of COVID-19, the decision to wear masks can be fraught with political overtones. People may feel guilty for not wearing a mask or moral outrage when asked to do so: “It is my health and my body; I can do what I want!” Many veterans feel stress because they are either not treated well or ongoing issues of PTSD and Military Sexual Trauma are ignored. Micro-aggression. Implicit Racial Bias. White Privilege. The list goes on.

WHY IS A POSITIVE TURN SO IMPORTANT?

To be clear, there are significant injustices and inequities. And they need to be identified and addressed. However, in my view, the field of wellness, well-being, and health promotion comes from the positive psychology, humanistic, and human potential perspective. It is aspirational, intentional, and transformative.

When I teach wellness courses, coach, or consult I see so much more energy, hope, and optimism – fuel for health – when the exercises, conversations, and strategies aspire to obtain the good, the beautiful, and the true.

When we empower others – especially as teams or groups – to get in touch with their own moral compass, their common set of values, their vision, or mission, the culture of that group shifts.

The focus is less on the problem and more on the solution. There is movement from stress, right on through resilience, to thriving and flourishing (see “Raw Coping Power: From Stress to Thriving”). The entire set-point is raised. Indeed, research shows that we can achieve enduring (if not permanent) shift in well-being by treating others well (Lickerman, 2013). If you are interested in becoming a "Resilience & Thriving" facilitator, visit the training information at the National Wellness Institute.

The “Greater Good Science Center” (GGSC) at the University of Berkeley is perhaps the best place to find practices and science-based resources for ethical health, although GGSC does not call it that. GGSC promotes ethical health through clear focus on prosociality, based partly on the work of its founding director, Dr. Dacher Keltner.  GGSC provides many tools and articles on how to cooperate, forgive, speak civilly, and practice kindness within communities.

I asked Dr. Keltner why there is not a more positive focus on ethical health. He suggested that we so often cast aspersions upon "ethics", or don't teach them (e.g., in business schools), or assume they are religious. His response reminded me of the work of the French philosopher, Tielhard de Chardin, mentioned above.  De Chardin saw ethics in a much more positive, uplifting, and transpersonal way (see Savary, 2019).

For example, instead of focusing on what we should not do, let’s focus on what we can do, what we are called to do, for the good of ourselves and others.

Instead of teaching about the many and diverse faces of sin to avoid, let’s focus on how we can consciously choose from a vast array of personal and collective good behaviors.

Instead of working to repair the past mistakes of immoral behavior (e.g., through confession, justice, owing debts, etc.), let’s get busy on doing the transformational work of the future, on the possible evolution of humanity.

We can start with just these few examples of prosociality, following our calling, educating on the diversity of positive behaviors, and moving with others toward a new vision. Investment in any of these, together and separately, will inevitably lead to positive increases in both individual and collective well-being. Because the field of wellness already provides a “map” of different positive dimensions, adding “ethical health” to this map, may help many to see it a new positive light.

INTERDIMENSIONALITY

So, how exactly does ethical health inform the other dimensions of wellness and how do these dimensions inform ethic health? This is the purpose of this article: a call for both a wellness science and practice that needs to be fully developed to help bring wellness into a full maturity. There is already quite a lot of research available. It will help us to find the intersections, identify practices, and develop tools and training that bring these “areas of wholeness” into society.

I have started a list below but primarily for the purpose of showing that there is a vast field of work that can be more fully developed. Please explore more with others. As an endeavor respectful of the mutuality of ethical health, we have to (“should”) explore it with others. As with anything pertaining to the moral dimension of life, it is not a question of what is necessarily the most beneficial or efficacious (typical of the realm of business) but rather what we “ought” to do that will advance the positive social values noted at the beginning of this article.

Physical Health: What types of positive behaviors (e.g., altruism, compassion, generosity) improve physical health status? How does this happen? What happens to our physical health when we act in ways that are not aligned with our values? (Research Idea: The literature on Type A behaviors and associated hostility suggests that managerial cardiovascular health correlates with increased hostility and anti-social orientation.)

Social Health: Consider our conversations and activities involving conflict and moral dilemmas with others; in families, workgroups, teams, classrooms, and regarding multicultural issues (inter-group versus intra-group empathy). How do these border on or require ethical decision-making? How does moral activity (e.g., civic participation, volunteering) improve the social health (cohesiveness, cooperation, climate) of groups, workplaces, families? (Research Idea: The research literature on empathy, compassion, and prosocial behavior can help inform ways that education in ethics improves social health).

Intellectual: What role does moral education in social cognition (e.g., avoiding bias, challenging stereotypes) play in developing intellectual capabilities? How can discernment, solving moral dilemmas, developing new models of decision-making, engaging interdisciplinary thinking be used to improve moral action? How can well-being be improved through these types of ethically-guided activities? (Research Idea: The research literature on authenticity and honest self-expression of ideas can be potentially used to guide an evidence-based ethics).

Occupational: How is employee well-being improved when leaders, supervisors, coworkers act in benevolent, altruistic ways? Can we distinguish between human resource practice, policies, and benefits that are more “morally sound” than other and what impact do these have on the entire culture of wellness at work? (Research Idea: The study of organizational citizenship applies to health as well as to a wide range of workplace policies, organizational values, behavior codes, codes of excellence, and compliance factors that are part of work culture and practice.)[1]

Emotional Health: How do values and individual alignment or misalignment in values play a role in happiness (on the positive side) or in difficult emotional states (anxiety, stress, depression)? What happens do us emotionally when we get triggered by others or experience breaches of conduct and how can moral principles be applied to help manage these difficult emotional states? (Research Idea: A variety of stress management tools can be applied to help people deal with emotions to promote healthy communication).

Spiritual Health:  How is it possible to have a sense of purpose, meaning, and fulfillment without ethical health? Can this be achieved without religion and only through education on transcendental values that are universal and not necessarily wedded to a religion? (Research Idea: A variety of measures of spiritual health and self-transcendence likely correlate with ethical factors).

The day will come when, after harnessing space, the winds, the tides, gravitation, we shall harness for God the energies of love. And, on that day, for the second time in the history of the world, humanity will have discovered fire. – Tielhard de Chardin

 

[1] My organization (OWLS) received funding from NIH to create a leadership development program that included training managers on ethical health. The brief self-assessment tool used in that program is provided above.