[Value judgments in the determination of a medical indication - An interdisciplinary analysis]

Medical indications are based on a synthesis of medical expertise, professional ethical standards, and legal requirements. This paper examines the extent to which value judgments influence these determinations and how they can be ethically approached.The interdisciplinary conceptual and normative analysis incorporates theoretical approaches from medical science, case studies, empirical findings, and legal considerations to identify and critically discuss the various levels of value judgments involved in the indication process.Value judgments influence determining medical indications, particularly with regard to the choice of one of the goals of medicine and how probabilities, uncertainties, personal attitudes, and social norms, are handled. Some judgments do not fall within the physician's scope of responsibility, at least not in the context of medical indication, e.g., economic or allocation considerations. For clarity, it is essential to differentiate physicians' assessments and patients' preferences, to explicate professional values, and to integrate assessments and individual values within decision-making processes.Value judgments made in determining a medical indication are unavoidable and must be carefully considered. Values should be made transparent in order to justify medical interventions that are judged to be indicated or not by physicians on a case-by-case basis and to strengthen patients' self-determination. A social debate is needed on how to appropriately address considerations (such as economic) which should not be mixed up with medical indications.