Philosophy

An electron clearly has the property of having a charge of þ1.6 Â 10À19 coulombs, but does it also have the property of being charged ? Philosophers have worried whether so-called 'determinable' predicates, such as 'is charged', actually refer to determinable properties in ...

"Values-Based Practice (VBP), developed as a partner theory to Evidence-Based Medicine (EBM), takes into explicit consideration patients’ and clinicians’ values, preferences, concerns and expectations during the clinical encounter in order to make decisions about proper interventions. While we believe that VBP adds an important dimension to the clinician's reasoning and decision making procedures, we argue that it ignores many of the implications that stem from certain psychiatric disorders altering the patient’s capacity to value. Taking depression as our example, and drawing on recent work in phenomenological psychopathology, we argue that cases of severe depression are often characterized by a loss or degradation of the capacity to be affected, both perceptually and emotionally. This loss of affectivity entails a further loss of the capacity to find anything meaningful or significant, limiting the depressed person's capacity for valuing anything at all (whether these be lifestyles, family members, vocations, etc.). Further, patients often lose the typical capacity to transcend their current situation and reinterpret themselves in light of future possibilities. This loss of transcendence results in a loss or degradation of the life narrative whereby one makes sense of oneself and one’s life.
VBP takes seriously the importance of life narratives, as well as how such narratives fundamentally shape the patient's values. However, it does not acknowledge the possibility and implications of severe existential changes that degrade the patient’s ability to value, alienating them from their own life narrative. We believe that such possibilities must be accounted for and integrated into the VBP system in order to be effectively applied in cases of clinical decision making regarding patients with severe psychiatric disorders. While such an integration cannot take place in the span of this paper, we follow the above discussion by proposing modifications to the current system of VBP (e.g. proxies, or written statements of value generated by the patient prior to an episode) that would allow it to contend with such cases effectively.
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Values-Based Practice (VBP), developed as a partner theory to Evidence-Based Medicine (EBM), takes into explicit consideration patients’ and clinicians’ values, preferences, concerns and expectations during the clinical encounter in order to make decisions about proper interventions. VBP takes seriously the importance of life narratives, as well as how such narratives fundamentally shape the patient's and clinician’s values. It also helps to explain difficulties in the clinical encounter as conflicts of values. While we believe that VBP adds an important dimension to the clinician's reasoning and decision making procedures, we argue that it ignores the degree to which values can shift and change, especially in the case of psychiatric disorders. VBP does this in three respects. First, it does not appropriately engage with the fact that a person’s values can change dramatically in light of major life events. Second, it does not acknowledge certain changes in the way people value, or in their modes of valuing, that occur in cases of severe psychiatric disorder. And third, it does not acknowledge the fact that certain disorders can even alter the degree to which one is capable of valuing anything at all. We believe that ignoring such changes limits the degree to which VBP can be effectively applied to clinical treatment and care. We conclude by considering a number of possible remedies to this issue, including the use of proxies and written statements of value generated through interviews and discussions between patient and clinician.