Values based practice and authoritarianism

Abstract

Values based practice (VBP) is a radical view of the place of values in medicine which develops from a philosophical analysis of values, illness and the role of ethical principles. It denies two attractive and traditional but misguided views of medicine: that diagnosis is a merely factual matter and that the values that should guide treatment and management can be codified in principles. But, in the work of KWM (Bill) Fulford, it goes further in the form of a radical liberal view: that the idea of an antecedently good outcome should be replaced by that of a right process. That however leads to a dilemma as to whether it can account for its own normative status. Given that difficulty, why might one adopt the radical version? I sketch a possible motive drawing on Rorty’s rejection of authoritarianism which replaces objectivity with solidarity as the aim of judgement. But I argue that, nevertheless, this does not justify the rejection of the more modest particularist version of VBP.