Another argument for values-based medicine

Abstract

There is a contemporary dialectic concerning the status of evidence-based medicine, criticising it for being ‘scientistic’, epistemologically inconsistent, rigid and dismissive of non-numerical sources of knowledge. A host of alternative frameworks has been proposed, including values-based medicine, narrative medicine, patient-centered care and personcentered medicine. Person-centered medicine is amongst the most persuasive and well-argued models. Miles and Mezzich [1] have argued in a major article that person-centered medicine employs theories of personhood to elaborate and justify its epistemology and praxis. At the same time, they claim that person-centered medicine is an ‘emergent’ concept that needs no base or foundation to justify it. We believe, however, that without some foundational values to underpin the status claimed for personhood, the arguments for person-centered medicine are incomplete. We therefore propose a set of foundational values – survival, security and flourishing – that underpin individual and social functioning transculturally. While these values are the same in all cultures, their expressions differ from culture to culture. Importantly, our notion of values is only modestly foundational. Modest foundationalism recognises that foundational propositions are only ‘warrantable assertions’ that may very well change in time and place. Foundational values in this sense are pragmatic and heuristic in kind and not normative. We enter a plea for their recognition in the form of the values-based medicine we describe. Keywords Evidence-based medicine, medical epistemology, modest foundationalism, person-centered medicine, values-based medicine