Political Liberalism and Values-Based Practice: Processes Above Outcomes or Rediscovering the Priority of the Right Over the Good

Abstract

The central idea of values-based practice is that clinical judgements should accommodate 'dissensus' by concentrating on right processes rather than good outcomes. Dissensus, however, has a philosophical history in political theory, especially liberal political theory, which may provide further tools for values-based practice. But it is not without difficulty. Rawlsian political theory aims to limit dissensus by presupposing rational consensus. Agonistic liberalism, although more promising, still leaves the problem of how conflicting views can be understood without presupposing some basic shared agreement.

Values‐based practice: Fulford's dangerous idea

“…All of which is not to deny the importance of ongoing philosophical work in evidence‐based practice as indeed in values‐based practice. In respect of values‐based practice, for example, the political philosopher Jon Rubin has pointed out that ‘dissensus’, a key concept guiding partnership in values‐based decision making, has clear resonances with concepts that were widely debated in the 19th century in the early days of the development of modern political democracies. Similarly, drawing on the philosophy of science, Thornton, writing elsewhere, has highlighted the importance both of tacit knowledge and of the irreducibility of individual judgement in clinical decision making : both of these are central to the processes by which values‐based practice is combined with other approaches (including evidence‐based practice) at the sharp end of clinical decision making.…”

Radical liberal values‐based practice

“…But this VBP claim seems to go further and to replace the idea of there being a right or good outcome with a right process (cf. [15]). This thought is further reinforced by the claim that 'communication skills have a substantive rather than (as in quasi-legal ethics) a merely executive role in clinical decision-making'.…”