Values-based medicine derives from an approach first introduced into the philosophy of psychiatry, which aims to demonstrate that the reality of mental illness is not inconsistent with the scientific status of medicine. Associated primarily with the work of K.W.M. Fulford, the argument is that practitioners need to be ethical anti-descriptivists if they are to avoid the authoritarianism of evidence-based medicine, which overlooks the fact that genuine value conflicts can arise during all clinical encounters, and that psychiatry is just the most explicit area in which these occur. This paper takes a philosophically therapeutic line and argues that, by reducing values to the status of preferences, antidescriptivism undermines the value of 'value' and leaves the practitioner with a reduced ability to discern and negotiate genuine conflicts of value. The conclusion is that patients should be respected, not as instantiations of preferences but as valuers; and that this requires practitioners to become more cosmopolitan and sympathetic, not more theoretically sophisticated.


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pp. 87-96
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