Abstract: This paper reflects on the relevance of morality, moralism, and ethics, as conceptual foundations drawn on the theoretical framework of Principles of Biomedical Ethics by Beauchamp and Childress, in the context of proximity intervention. It examines how shared and specific moral systems can influence decision-making and relational dynamics in socially vulnerable contexts between individuals, communities, and/or organizations. The analysis considers how culturally grounded, ethical interventions can support the promotion of human rights and the reduction of risk among marginalized populations, such as people who use drugs and sex workers, advocating for participatory, rights-based approaches that prioritize dignity, autonomy, and social justice.
Keywords: Moralities, Moralism, Ethics, Proximity Intervention, Human Rights, Risk Reduction.
 
Content:
Proximity interventions, which are characterized by direct, trust-based relationships with individuals and communities, play a crucial role in addressing complex social issues, including public health, social exclusion, and human rights violations.[1] These interventions are particularly relevant for populations facing structural vulnerability, such as people who use drugs or sex workers.[2, 3] However, such work is inherently shaped by normative frameworks—both implicit and explicit—related to morality, ethics, and power. This paper seeks to reflect on the influence of moralities, moralism, and ethics on proximity interventions and to argue for ethically grounded, culturally competent practices that center the lived experiences of affected communities. Drawing from bioethics, human rights, and harm reduction literature, the analysis highlights the implications of ethical reflection for intervention design, implementation, and policy advocacy.
 
Morality and Moralities:
 
According to Beauchamp and Childress (2013), morality consists of broadly shared norms that determine what is right and wrong in human conduct. These norms form the foundation of social cohesion and ethical reasoning. Common morality includes universal principles such as non-maleficence, justice, and respect for life, while particular moralities reflect the specific values, responsibilities, and cultural norms of social, professional, or institutional groups.[4]
 
Moralism:
 
Moralism occurs when specific moral convictions are imposed on others as if they held universal authority. Moralists often conflate their own cultural or personal values with the common morality, leading to exclusionary or punitive practices. While their beliefs may be sincere and even ethically commendable, their application across diverse contexts risks marginalizing individuals who do not share the same norms.[4]
 
Ethics:
 
Ethics entails a critical and systematic examination of moral life. It asks questions such as: Which moral norms should guide our actions, and why? Ethical reasoning involves defining, justifying, and applying principles to specific dilemmas in professional practice, public policy, and social relations. In proximity interventions, ethics serves as a tool for navigating the complexities of cultural difference, power asymmetries, and moral pluralism. [1,4]
 
Ethics in Proximity Intervention:
 
Proximity intervention involves building close, direct, flexible and sustained relationships with vulnerable individuals and/or communities being helped, often in relation to the promotion or protection of human rights (e.g. access to healthcare or justice), risk reduction, and harm minimization. It is premised on understanding individuals' needs in their specific social, cultural, and political contexts.[1]
 
The ethical dimension of proximity intervention requires recognizing all participants as moral agents with their own values, and “places of speech”.[5] These agents are the Individual(s) or community(ies) and professional(s) or organization(s) undertaking the intervention, stakeholders that possess their own “culture” as well as distinct moralities, knowledge systems, and lived experiences, all of which shape their capacity for perception, interpretation, and decision-making within a given sociocultural framework. Interventions that are grounded in the lived realities and local cultural contexts of individuals— being culture the shared set of beliefs, values, behaviors, and practices that define the community —rather than in the moralities or assumptions of socially privileged and dominant groups.
 
Therefore, the relational nature in the proximity intervention, must be guided by principles and actions that:
• Foster cultural competence and contextual understanding;
• Respect for informed consent;
• Promote advocacy, the defense of dignity, autonomy, self-determination, and protection of social and human rights.
 
Ethics, Risk Reduction, and Human Rights:
 
Proximity interventions must be rooted in the specific realities of the communities they serve. Interventions that rely on dominant or moralistic frameworks—rather than the situated knowledge of marginalized groups—risk perpetuating harm and social exclusion. Instead, participatory models grounded in the motto “Nothing About Us Without Us” must be promoted. [6] The participatory models offer a pathway toward social justice and sustainable change, by promoting empowerment, active, democratic, and direct participation of individuals, in the design and implementation of public policies and interventions intended to mitigate their own risk factors, while protecting human rights.
Several initiatives illustrate ethically grounded, proximity-based approaches to risk reduction:
• Needle and Syringe Exchange Programs, a response to the HIV and HCV epidemics among people who use drugs, through non-judgmental, public health strategies [7, 8]
• Naloxone distribution programs, aiming to prevent opioid overdoses by equipping communities with life-saving tools; [9]
• The Red Umbrella Fund, a global participatory fund led by sex workers [10], and local advocacy efforts such as the POWER project (by APDES/Porto G), which support sex workers’ self-determination and political voice.[3]
 
Conclusion:
 
Moralities, moralism, and ethics are deeply interrelated constructs that shape both interpersonal relationships and institutional policies. Their understanding is essential for proximity intervention professionals tasked with building trust, navigating cultural complexity, and addressing systemic inequalities. Morality and ethics influence not only the formulation of public policies and legal instruments but also their practical application and impact in real-life contexts. Crucially, the full and direct participation of those affected by intervention—particularly marginalized communities—is indispensable. Empowerment, informed consent, and cultural responsiveness are not just ethical imperatives but foundational to the effectiveness, relevance, and sustainability of social interventions. Ultimately, proximity intervention that is ethically reflective and human rights-based contributes to greater social inclusion, risk reduction, well-being, and justice.
 
References
1. ACIS+ Modulo 2, APDES, Manual de Intervenção de Proximidade - Teoria e Prática, Portugal.2. APDES/Porto G. (2022). POWER Project: Advocacy and Empowerment of Sex Workers in Portugal.3. United Nations Office on Drugs and Crime (UNODC). (2017). Implementing Comprehensive HIV and HCV Programmes with People Who Inject Drugs.4. Beauchamp, T. L., & Childress, J. F. (2013). Principles of Biomedical Ethics (7th ed.). Oxford University Press.5. Ribeiro, D. (2017). O que é lugar de fala? São Paulo: Letramento.6. INPUD (International Network of People who Use Drugs). (2019). Nothing About Us Without Us.7. WHO (World Health Organization). (2014). Consolidated Guidelines on HIV Prevention, Diagnosis, Treatment and Care for Key Populations.8. EMCDDA (European Monitoring Centre for Drugs and Drug Addiction). (2020). Harm Reduction Overview: Portugal.9. Harm Reduction International. (2023). Naloxone: Preventing Opioid Overdose Deaths.10. Red Umbrella Fund. (2023). Annual Report.

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