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damaging. For example, Loughlin sees value-free approaches as destructive; negatively
affecting individual consciousness and society at every level. She believes that
objective approaches are alienating, they set us apart in a destructive way from the
world we know, causing us to ignore or devalue those subjective capacities which could
enrich our awareness of the world (1998, p. 1). Even to consider that solely objective
reasoning might be a possibility is to depict man as an automaton, devoid of feelings,
emotions, life experience and removed from his social or cultural environments.
These are the value-free philosophical underpinnings of modern legal and health care
systems which guide treatment and non-treatment decisions on behalf of adults who
lack capacity. In reality, scientific and rationalist paradigms do not eliminate values
from decision making. Instead, denying the relevance of values results in best interest
determinations according to the decision maker’s own unspecified values.
Values and reasoning
Contemporary theorists have attempted to re-dress the balance, particularly in relation
to health care decision making. Fulford (2004) has developed what he describes as the
counterpart to evidence-based medicine. Values-based medicine (VBM) “is the theory
and practice of effective health-care decision making for situations in which
legitimately different (and hence potentially conflicting) value perspectives are in play”
(2004, p. 205). He argues that in values-based medicine, awareness, knowledge and
ethical reasoning are combined with communication skills to effect action (2004, p.
223). Central to Fulford’s theory is a fact + values model of reasoning. Fulford argues
that values and evidence are “the two feet on which all decisions in health (and any
other context) stand” (p. 209).
Seedhouse’s theory of values-based decision-making is similarly concerned with the
decision making process and exposing the values which drive and inform decision
making. Values-based decision-making is based on the philosophical tenet that decision
making is necessarily a combination of values and evidence. “Obviously all decisions
are a balance of evidence and values. Obviously we should regard values as at least
equally important as evidence. And yet we don’t” (Seedhouse, 2005, p. 23). My theory
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