The Values Alphabet

 

Besides the distinct values tools illustrated in this section there is a growing variety of resources within values-based approaches

There are also discipline-specific varieties such as VBCAMHS (for young people’s mental health services) and VB Surgical care

Yet further variety is added by approaches that although sharing many aspects of values-based practice are differently badged

  • Batho PeleWerdie van Staden’s African VBP See van Staden, W and Fulford, K.W.M., (forthcoming, 2015) The Indaba in African Values-based practice: respecting diversity of values without ethical relativism or individual liberalism. Ch 28, in Sadler, J.Z., van Staden, W., and Fulford, K.W.M., Eds The Oxford Handbook of Psychiatric Ethics. Oxford: Oxford University Press
  • EBM – in David Sackett’s original formulation evidence-based medicine itself includes a central feature of values-based practice, its attentiveness to the diversity of individual values See Missing Links with Evidence-based Practice in Links between Other Tools and Values-based Practice
  • FAP – Miles Little’s formulation of values-based medicine based on combining Foundations, Axioms and Principles See Little, M., (2014) Values, foundations and being human. Chapter 14 pps 171 – 183 in Loughlin, M., (ed) Debates in values-based practice: arguments for and against. Cambridge: Cambridge University Press
  • VExDavid Seedhouse’s web-based training support tool, the Values Exchanges See On-line Resources in Teaching and Learning

The Challenge of Pluralism

A natural response to this growing variety is to say ‘so which is the best? Let’s do an impact study and settle on the right one.’

The moral and political philosopher Isaiah Berlin warned against any such move to values monism while at the same time spelling out the deeply challenging nature of pluralism

  • Berlin, I., (1958) Two Concepts of Liberty. Oxford: Clarendon Press

Discussed in

  • Crowder, G., (2002) Liberalism and Value Pluralism. London and New York: Continuum

And for an example of the challenge of pluralism in values-based practice

  • Fulford, K.W.M., Dewey, S., and King, M.(forthcoming, 2015) Values-based Involuntary Seclusion and Treatment: Value Pluralism and the UK’s Mental Health Act 2007. Ch 60, in Sadler, J.Z., van Staden, W., and Fulford, K.W.M., (Eds) The Oxford Handbook of Psychiatric Ethics. Oxford: Oxford University Press

The pluralism of values-based practice engages rather with an open and context-sensitive development in which the unique features of different approaches are combined in different ways to meet different ends.

  • Fulford, K.W.M. and Little, M., (2014) Walking the V-B talk: concluding reflections on models, methods and practical pay-offs. Chapter 22 pps 265 – 271 in Loughlin, M., (ed) Debates in values-based practice: arguments for and against. Cambridge: Cambridge University Press

There are many current examples of the effectiveness of such values pluralism. Among Collaborating Centre partners for example

  • Joshua Hordern’s Oxford Healthcare Values Partnership is explicitly open and inclusive in its aims and methods
  • Muir Gray and Anant Jani’s program in High Value Healthcare at the Institute for Value Based Healthcare builds on their triple value model combining allocative, technical and personal value.

Values-based commissioning (see in Policy and Service Development, Practice Guidance and Commissioning) has taken a number of different forms ranging from those close to values-based practice

through a variety of outcomes-focused and patient-centered versions

to others that model most closely David Sackett’s original three-part conception of Evidence-based Medicine (see Missing Links with Evidence in Links between Other Tools and Values-based Practice)

In supporting Research and On-going Development in values-based practice the Collaborating Centre will seek to meet Berlin’s challenge of pluralism through an open and inclusive approach reflecting the rich resources of the Values Toolkit.