VALUES-BASED MEDICINE AND MODEST FOUNDATIONALISM

Abstract

Values-based medicine can be interpreted in economic terms as the medicine that delivers the most benefit for a given cost. But values have another meaning in philosophy. They refer to the basic commitments that justify judgements, beliefs and practices, both at community and personal levels. The study of these kinds of values is axiology, and they are the subject of this article. There may be debate about the ontology and epistemology of values of this kind, but this need not stop their empirical exploration, nor their deployment in constructing a theoretical basis for health care and a framework for medical practice, medical research and medical education. We suggest that all peoples subscribe to three foundational values – survival, security and flourishing – and that these foundational values are expressed by way of concepts, systems, principles and practices that may differ substantially from culture to culture. Many ethical quandaries can be better understood, even though they may remain unsolved, by reference to the foundational values that people can agree upon. It becomes clear that disputes and dilemmas arise because of differences in the ways that values are expressed in cultures, particularly in pluralist societies. Yet agreement can be obtained about foundational values, and dialectic may be better focused by returning to them in discussions involving individuals or groups with different preferences. Values-based health care has strong claims to prior logical status as a justification for the whole enterprise of health care, and values-based medicine is a part of this larger domain. To accept VBM is to accept subtle but important differences in the conduct of medical practice, medical research and medical education. KEY WORDS Values; values-based medicine; evidence-based medicine; medical education; medical research; medical practice