Overstating values: medical facts, diverse values, bioethics and values-based medicine

Area of Science:

• Medical Philosophy
• Bioethics
• Philosophy of Medicine

Background:

• Fulford's 'reverse' model posits illness, disease, and dysfunction as inherently evaluative, with illness preceding disease.
• This challenges the conventional value-free medical model, advocating for a greater emphasis on values in medicine.
• Values Based Medicine (VBM) aims to rebalance the focus on facts, especially with advancements in medical science increasing patient choices.

Purpose of the Study:

• To critically evaluate Fulford's 'reverse' model and Values Based Medicine (VBM).
• To examine the relationship between descriptive and evaluative meanings in medical concepts.
• To compare VBM with quasi-legal bioethics and evidence-based medicine (EBM) in handling medical values.

Main Methods:

• Conceptual analysis of medical terminology (illness, disease, dysfunction).
• Application of Hare's distinction between description and evaluation.
• Comparative analysis of VBM, quasi-legal bioethics, and evidence-based medicine (EBM).

Main Results:

• While supporting VBM's emphasis on values, the critique finds it overstates value complexity and misrepresents EBM.
• VBM incorrectly portrays quasi-legal bioethics as solely based on settled descriptive meaning.
• Bioethical reasoning effectively reveals attempts to reduce values to facts, challenging VBM's unique advantage.

Conclusions:

• VBM offers no superior method for delineating the interplay between facts and values in medicine compared to bioethics.
• Bioethics provides a robust framework for analyzing the complex relationship between medical facts and diverse patient values.
• The study underscores the critical role of bioethical reasoning in navigating evaluative aspects of medical practice.