P 135 Conclusion

It could be debated whether advertising that goes beyond dissemination of information is ever ethical, though it is an accepted feature of market economies. The ethical issue for advertising is whether advertising is truthful and whether there can be objectively measurable standards for judging the truthfulness of advertising claims. A more problematic concern is the way in which advertising plays upon people's unconscious wishes and fantasies: sex, greed, and the quest for power, status, and perfection. The scientific basis for advertising rests on the ability to identify and manipulate such longings and fears. When one speaks of "the market" or "market forces" or "demand," one is generally talking about human wants and wishes.

Key questions facing the ethics of advertising in healthcare include:

• What standards or regulations should be in place concerning the placement of advertisements?

• Is any appeal legitimate so long as it does not mislead, make false claims, or actually harm?

• Is the negative portrayal of women in, for example, the promotion of unhealthful products such as tobacco or alcohol so morally offensive as to persuade the government to extend the scope of regulation of what is permissible in advertising, such as limiting advertising to dissemination of information?

• Is the effectiveness of the psychology of persuasion sufficient to justify advertisements, or can some higher principle be brought to bear?

Perhaps advertising itself should be subjected to the first principle of Hippocratic ethics, primum non nocere (first do no harm). Or to echo the caveat of President Dwight D. Eisenhower about the "military-industrial complex," beware the medical-industrial complex. Advertising that promotes consumer choice by providing information is consistent with the ethical ideal to promote patient autonomy. Advertising that deceptively promotes the interest of the provider at the expense of the consumer could not be ethically condoned, especially when the consumer is a patient.

ALLEN R. DYER (1 995) REVISED BY AUTHOR

SEE ALSO: Harmful Substances, Legal Control of; Lifestyles and Public Health; Medicine, Profession of; Pharmaceutical Industry; Professional-Patient Relationship; Profit and Commercialism

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