Open Access Open Access  Restricted Access Subscription Access

Values as ‘modest foundations’ for medicine

Miles Little, Jill Gordon, Wendy Lipworth, Pippa Markham, Ian Kerridge

Abstract


Medicine and healthcare have been around for thousands of years, but we seldom ask why they are so important. It seems self-evident that we should seek relief of suffering from some institution in the society in which we live and equally self-evident that each society should provide healthcare for its people at some level. Yet when we inquire further, we are driven to seek foundational answers to iterative questions, seeking answers at deeper and deeper levels. Ultimately, it seems best to accept the Humean refuge [1] and finish with some such statement as “Humans are like that” or “Societies can’t function in any other way”.

These Humean questions suggest that survival, security and flourishing are endpoints for such an inquiry and that medical (and many other) systems are built on these implicit foundations. The ways in which societies build relevant systems (such as medicine, welfare, law, transport, housing and so on) will differ strikingly, but common ground will still exist at the foundational level.

Acknowledging a commonality of foundations does not commit one either to a conservative normativity, nor to a loose relativism. Increasing activity at the level of the International Court of Justice makes clear that there is a possibility of consensus for judging the validity of the interpretations and enactments of foundational values in any society. The ideals of the American Declaration of Independence – life, liberty and the pursuit of happiness – are principles very similar to the foundational values of survival, security and flourishing. Person-centered medicine is inescapably based on theories of the person and must therefore be able to offer an account of what personhood is. Values underpin the philosophy and practice of medicine, including person-centered medicine, because they are foundations of personhood, as well as foundations of the societies in which each person lives.

Keywords


Discourse, evidence-based medicine, foundationalism, medical epistemology, narrative-based medicine, person-centered medicine, reform, values-based medicine

Full Text:

PDF

References


Hume, D. (1777; 2004). An Enquiry Concerning the Principles of Morals. New York: Prometheus Books.

Kaufman, S.R. (1993). The Healer's Tale: Transforming Medicine and Culture. Life Course Studies. D.I. Featherman & D.I. Kertzer. (Eds.). Madison, Wisconsin: University of Wisconsin Press.

Lens, P. & van der Wal, G.A. (Eds.). (1997). Problem doctors: a conspiracy of silence. IOS Press: Amsterdam.

Ferguson, E., James, D. & Madeley, L. (2002). Factors associated with success in medical school: systematic review of the literature. British Medical Journal 324 (7343) 952-957.

Charon, R. (1989). Doctor-patient/reader-writer: learning to find the text. Soundings 72, 137-152.

Charon, R. (2001). Narrative Medicine: A Model for Empathy, Reflection, Profession, and Trust. Journal of the American Medical Association 286 (15) 1897-1902.

Brown, J.B., Boles, M., Mullooly, J.P. & Levinson, W. (1999). Effect of Clinician Communication Skills Training on Patient Satisfaction. Annals of Internal Medicine 131 (11) 822-829.

Little, M. (1995). Humane Medicine. Cambridge: Cambridge University Press.

Skrabanek, P. (1994). The Death of Humane Medicine. Bury St Edmunds: Social Science Unit.

Ellrodt, G., Cook, D.J., Lee, J., Cho, M., Hunt, D. & Weingarten, S. (1997). Evidence-based disease management. Journal of the American Medical Association 278, 1687-1692.

Goldenberg, M.J. (2006). On evidence and evidence-based medicine: Lessons from the philosophy of science. Social Science & Medicine 62, 2621-2632.

Green, J. &Britten, N. (1998). Qualitative research and evidence based medicine. British Medical Journal 316 (7139) 1230-1232.

Grossman, J. (2008). A Couple of the Nasties Lurking in Evidence-Based Medicine. Social Epistemology: A Journal of Knowledge, Culture and Policy 22 (4) 333-352.

Guyatt, G. (1991). Evidence-based medicine. ACP Journal Club (Annals of Internal Medicine) 14 (Supplement 2) A-16.

Guyatt, G., Cairns, J,Churchill, D. & Evidence-Based Medicine Working Group. (1992). Evidence-based medicine. A new approach to teaching the practice of medicine. Journal of the American Medical Association 268, 2420-2425.

Guyatt, G., Cook, D. & Haynes, B. (2004). Evidence based medicine has come a long way. British Medical Journal 329 (7473) 990-991.

Kravitz, R.L., Duan, N. & Braslow, J. (2004). Evidence-Based Medicine, Heterogeneity of Treatment Effects, and the Trouble with Averages. The Milbank Quarterly 82 (4) 661-687.

La Caze, A. (2008). Evidence-Based Medicine Can’t Be…. Social Epistemology: A Journal of Knowledge, Culture and Policy 22 (4) 353-370.

Lipworth, W., Carter, S. & Kerridge, I. (2008). The "EBM movement": where did it come from, where is it going, and why does it matter? Social Epistemology: A Journal of Knowledge, Culture, and Policy 22, 425-431.

Miller, C.G. & Miller, D.W. (2011). The Real World Failure of Evidence-Based Medicine. International Journal of Person Centered Medicine 1 (2) 295-300.

Sackett, D.L., Rosenberg, W.M., Gray, J.A., Haynes, R.B. & Richardson, W.S. (1996). Evidence based medicine: what it is and what it isn't. British Medical Journal 312 (7023) 71-72.

Sackett, D.L., Richardson, W.S., Rosenberg, W.M. & Haynes, R.B. (2000). Evidence-Based Medicine: How to practice and teach EBM. New York: Churchill Livingstone.

Fulford, K.W.M. (2007). Values-based medicine: delusion and religious experience as a case study in the limits of medical-scientific reduction. In: The Science of Morality, G. Walker, (ed.). London: Royal College of Physicians.

Fulford, K.W.M. (2011). Bringing together values-based and evidence-based medicine: UK Department of Health Initiatives in the 'Personalization' of Care. Journal of Evaluation in Clinical Practice 17 (2) 341-343.

Little, M. (2002). Humanistic medicine or values-based medicine? What's in a name? Medical Journal of Australia 177 (6) 319-321.

Little, M., et al. (2011). Values-based medicine and modest foundationalism. Journal of Evaluation in Clinical Practice In press.

Little, M., Lipworth, W., Gordon, J. & Markham, P. (2011). Another argument for values-based medicine. International Journal of Person Centered Medicine 1 (4) 649-656.

Petrova, M., Dale, J. & Fulford, K.W.M. (2006). Values-based practice in primary care: easing the tensions between individual values, ethical principles and best evidence. British Journal of General Practice, 56 (530) 703-709.

Webb, D.J. (2011). Value-based medicine pricing: NICE work? Lancet 377 (9777) 1552-1553.

Greenhalgh, T. & Hurwitz, B., (eds.). (1998). Narrative Based Medicine: Dialogue and Discourse in Clinical Practice. London: BMJ Books.

Mattingly, C. & Garro, L.C., (eds.). (2000). Narrative and the Cultural Construction of Illness. Berkeley: University of California Press.

Henry, S.G., Zaner, R.M. & Dittus, R.S. (2007). Viewpoint: Moving beyond evidence-based medicine. Academic Medicine 82 (3) 292-297.

Miles, A. & Loughlin, M. (2011). Models in the balance: evidence-based medicine versus evidence-informed individualized care. Journal of Evaluation in Clinical Practice 17, 531-536.

Miles, A. & Mezzich, J.E. (2011). The care of the patient and the soul of the clinic: person centered medicine as an emergent model of modern clinical practice. International Journal of Person Centered Medicine 1 (2) 207-222.

Hoffman, K.G. & Donaldson, J.F. (2004). Contextual tensions of the clinical environment and their influence on teaching and learning. Medical Education 38 (4) 448-454.

Laine, C. & Davidoff, F. (1996). Patient-centred medicine: A professional evolution. Journal of the American Medical Association 275 (2) 152-156.

Frampton, S.B. & Guastello, S. (2010). Putting patients first: patient-centered care: more than the sum of its parts. American Journal of Nursing 110 (9) 49-53.

Guttmacher, S. (1979). Whole in Body, Mind & Spirit: Holistic Health and the Limits of Medicine. Hastings Center Report 9 (2) 15-21.

Siegler, M. (1994). Confidentiality in medicine - a decrepit concept. In: Contemporary Issues in Bioethics. T. Beauchamp & L. Walters, (eds.), pp. 179-181. Belmont, CA: Wadsworth Publishing.

Hirschkorn, K.A. & Bourgeault, I.L. (2005). Conceptualizing mainstream health care providers' behaviours in relation to complementary and alternative medicine. Social Science & Medicine 61 (1) 157-170.

Rose, J.H. (1993). Interactions between patients and providers: An exploratory study of age differences in emotional support. Journal of Psychosocial Oncology 11 (2) 43-67.

Dreier, O. (2000). Psychotherapy in clients' trajectories across contexts. In: Narrative and the Cutural Construction of Illness and Healing. C. Mattingly and L.C. Garro, (eds.), pp. 237-258. Berkeley: University of California Press.

Beisecker, A.E. & Beisecker, T.D. (1993). Using metaphors to characterize doctor-patient relationships: Paternalism versus consumerism. Health Communication 5 (1) 41-58.

Eysenbach, G. & Kohler, C. (2002). How do consumers search for and appraise health information on the world wide web? Qualitative study using focus groups, usability tests, and in-depth interviews. British Medical Journal 324, 573-577.

Gabbay, J., et al. (2003). A case study of knowledge-management in multi-agency consumer-informed 'communities of practice': implications for evidence-based policy development in health and social services. Health 7 (3) 283-310.

Health and Disability Commissioner. (1997). Code of Health and Disability Services Consumers' Rights. Auckland, New Zealand: New Zealand Health and Disability Commission.

Coleman, P.G. & Shellow, R.A. (1995). Privacy and autonomy in the physician-patient relationship: Independent contracting under Medicare and implications for expansion into managed care. Journal of Legal Medicine 16, 509-543.

Hitchens, C. (1998). Bitter medicine In: Vanity Fair 24-35.

Irvine, D. (2001). The changing relationship between the public and the medical profession. Journal of the Royal Society of Medicine 94, 162-169.

Sharpe, V.A. & Faden, A.I. (1998). Medical Harm: Historical, Conceptual, and Ethical Dimensions of Iatrogenic Illness. Cambridge: Cambridge University Press.

Handler, E. (1996). Time on Fire: My Comedy of Terrors. New York: Owl Books.

Buchanan, S. (1994). I'm Alive and the Doctor's Dead.Grand Rapids, Michigan: Zondervan Publishing House.

Harari, E. (2001). Whose evidence? Lessons from the philosophy of science and the epistemology of medicine. Australian & New Zealand Journal of Psychiatry 35, 724-730.

Kerridge, I., Lowe, M, & Henry, D. (1998). Personal paper: Ethics and evidence based medicine. British Medical Journal 316 (7138) 1151-1153.

Penston, J. (2011). The irrelevance of statistics-based research to individual patients. International Journal of Person Centered Medicine 1 (2) 240-249.

Raman, R. (2011). Evidence-based Medicine and Patient-centered Care: Cross-Disciplinary Challenges and Healthcare Information Technology-enabled Solutions. International Journal of Person Centered Medicine 1 (2) 279-294.

Timmermans, S. & Angell, A. (2001). Evidence-Based Medicine, Clinical Uncertainty, and Learning to Doctor. Journal of Health and Social Behavior 42 (4) 342-359.

Tonelli, M.R. (2006). Integrating evidence into clinical practice: an alternative to evidence-based medicine. Journal of Evaluation in Clinical Practice 12 (3) 248-256.

Upshur, R. (2002). If not evidence, then what? Or does medicine really need a base? Journal of Evaluation in Clinical Practice 8 (2) 113-119.

Worrall, J. (2002). What Evidence in Evidence-Based Medicine? Philosophy of Science 69 (3) S316-S330.

Eddy, D.M. (1992). Medicine, money and mathematics. American College of Surgeons Bulletin 77, 36-49.

Taylor, R. (1979). Medicine Out of Control - The Anatomy of a Malignant Technology Sydney: Sun Books.

Moynihan, R. (1998). Too Much Medicine? The Business of Health and the Risks for You. Sydney: ABC Books.

Illich, I. (1975). Medical Nemesis: The Expropriation of Health. London: Lothian Publishing.

Dutton, D.B. (1988). Worse than the Disease: Pitfalls of Medical Practice. Cambridge: Cambridge University Press.

Bourdieu, P. (2008). Outline of a Theory of Practice. Cambridge: Cambridge University Press.

Little, M., Gordon, J., Markham, P., Lipworth, W. & Kerridge, I. (2011). Making decisions in the mechanistic, probabilistic and scientific domains of medicine: a qualitative study of medical practitioners. International Journal of Person Centered Medicine 1 (2) 376-384.

Little, M., Gordon, J., Markham, P., Rychetnik, L. & Kerridge, I. (2011). Virtuous acts as practical medical ethics: an empirical study. Journal of Evaluation in Clinical Practice, 17, 948-953.

Allott, R. (1991). Objective morality. Journal of Social and Biological Structures 14 (4) 455-471.

Curry, O. (2006). Who's afraid of the naturalistic fallacy? Evolutionary Psychology 4, 234-247.

Hook, S.W., (ed.). (2010). Democratic Peace in Theory and Practice. Kent: Kent State University Press.

Miles, A. & Mezzich, J.E. (2011). Person-centered Medicine: advancing methods, promoting implementation. International Journal of Person Centered Medicine 1 (3) 423-428.

Fulford, K.W.M. (2004). Fact/values: ten principles of values-based medicine. In: The Philosophy of Psychiatry: A Companion. J. Radden, (ed.), pp. 205-234. Oxford: Oxford University Press.

Little, M. (2000). Ethonomics - the ethics of the unaffordable. Archives of Surgery 135, 17-21.

Mann, G.G. (1988). Ethonomics: An Enquiry into the Nature and Causes of the Wealth of Individuals. Ascot, Berkshire: Springwood Books.

Daniels, N. (1980). Reflective equilibrium and Archimedian points. Canadian Journal of Philosophy 10, 83-103.

Daniels, N. (1996). Justice and Justification: Reflective Equilibrium in Theory and Practice. Cambridge: Cambridge University Press.

DePaul, M.R. (2001). Balance and Refinement: Beyond Coherence Methods of Moral Inquiry. London: Routledge.




DOI: http://dx.doi.org/10.5750/ejpch.v2i2.702

Refbacks

  • There are currently no refbacks.