Morality, Power and the Planning Subject

Ethical issues are at the heart of planning. Thus, planning theory has long displayed an interest in debating both the ethical justification for planning and how the activity of planning can be rendered more ethically sensitive. However, comparatively little attention has been shown to how the very constitution of the planner as a ‘moral subject’ may be ethically problematic for planning practice. This article addresses this lacuna through an engagement with the philosophy of Michel Foucault. In contrast to how his work is normally applied, this article accords with Foucault’s own direction that his later examination of ethics be used as a lens through which to read his earlier analysis of power and knowledge. Accordingly, the article first outlines Foucault’s innovative reinterpretation of how power and knowledge operate in society before setting this within his novel reconception of ethics. This theoretical exposition is then employed to interpret the material drawn from in-depth qualitative interviews with 20 planning officers working in a range of different contexts. The article subsequently employs Foucault’s ethically informed reading of power and knowledge to identify ethical issues arising from the approaches used by practitioners to justify their planning activities. The article concludes by suggesting how such issues can be resolved.

Effect of implementation of a preconception counselling resource for women with diabetes: A population based study

Aim To evaluate the effect of regional implementation of a preconception counselling resource into routine diabetes care on pregnancy planning indicators. Methods A preconception counselling DVD was distributed to women by diabetes care teams and general practices. Subsequently, in a prospective population-based study, pregnancy planning indicators were evaluated. The post-DVD cohort (n = 135), including a viewed-DVD subgroup (n = 58), were compared with an historical cohort (pre-DVD, n = 114). Primary outcome was HbA1c at first diabetes-antenatal visit. Secondary outcomes included preconception folic acid consumption, planned pregnancy and HbA1c recorded in the 6 months preconception. Results Mean first visit HbA1c was lower post-DVD vs. pre-DVD: 7.5% vs. 7.8% [58.4 vs. 61.8 mmol/mol]; p = 0.12), although not statistically significant. 53% and 20% of women with type 1 and 2 diabetes, respectively, viewed the DVD. The viewed-DVD subgroup were significantly more likely to have lower first visit HbA1c: 6.9% vs. 7.8% [52.1 vs. 61.8 mmol/mol], P < 0.001; planned pregnancy (88% vs. 59%, P < 0.001); taken folic acid preconception (81% vs. 43%, P = 0.001); and had HbA1c recorded preconception (88% vs. 53%, P < 0.001) than the pre-DVD cohort. Conclusions Implementation of a preconception counselling resource was associated with improved pregnancy planning indicators. Women with type 2 diabetes are difficult to reach. Greater awareness within primary care of the importance of preconception counselling among this population is needed.