Radical liberal values‐based practice

Thornton, Tim

doi:10.1111/j.1365-2753.2011.01733.x

Cited by 25 publications

(27 citation statements)

References 12 publications

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“…These values are not always obvious in everyday work since we only tend to notice them when they differ or are conflicting [1,2]. In such situations values will become apparent and standard ways of interacting with patients may be challenged.…”

Section: Introductionmentioning

confidence: 99%

Paternalism, autonomy and reciprocity: ethical perspectives in encounters with patients in psychiatric in-patient care

Pelto‐Piri

Engström

2013

BMC Med Ethics

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BackgroundPsychiatric staff members have the power to decide the options that frame encounters with patients. Intentional as well as unintentional framing can have a crucial impact on patients’ opportunities to be heard and participate in the process. We identified three dominant ethical perspectives in the normative medical ethics literature concerning how doctors and other staff members should frame interactions in relation to patients; paternalism, autonomy and reciprocity. The aim of this study was to describe and analyse statements describing real work situations and ethical reflections made by staff members in relation to three central perspectives in medical ethics; paternalism, autonomy and reciprocity.MethodsAll staff members involved with patients in seven adult psychiatric and six child and adolescent psychiatric clinics were given the opportunity to freely describe ethical considerations in their work by keeping an ethical diary over the course of one week and 173 persons handed in their diaries. Qualitative theory-guided content analysis was used to provide a description of staff encounters with patients and in what way these encounters were consistent with, or contrary to, the three perspectives.ResultsThe majority of the statements could be attributed to the perspective of paternalism and several to autonomy. Only a few statements could be attributed to reciprocity, most of which concerned staff members acting contrary to the perspective. The result is presented as three perspectives containing eight values.•Paternalism; 1) promoting and restoring the health of the patient, 2) providing good care and 3) assuming responsibility.•Autonomy; 1) respecting the patient’s right to self-determination and information, 2) respecting the patient’s integrity and 3) protecting human rights.•Reciprocity; 1) involving patients in the planning and implementation of their care and 2) building trust between staff and patients.ConclusionsPaternalism clearly appeared to be the dominant perspective among the participants, but there was also awareness of patients’ right to autonomy. Despite a normative trend towards reciprocity in psychiatry throughout the Western world, identifying it proved difficult in this study. This should be borne in mind by clinics when considering the need for ethical education, training and supervision.

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Section: Introductionmentioning

confidence: 99%

Paternalism, autonomy and reciprocity: ethical perspectives in encounters with patients in psychiatric in-patient care

Pelto‐Piri

Engström

2013

BMC Med Ethics

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“…Further, the way Thornton14 describes values-based practice in terms of its process being the end in itself is a misleading overstatement.…”

Section: Right Outcomes or Good Processes?mentioning

confidence: 99%

“…Moreover, the process of values-based practice is an ‘end itself’ (as Thornton14 puts it), in the sense that people’s capabilities for thinking, believing and feeling probably increase in the process, a process where different values are recognised and discussed together. This process increases the capabilities of service users but also those of the treatment providers and all others who take part in it.…”

Section: Right Outcomes or Good Processes?mentioning

confidence: 99%

Promoting the freedom of thought of mental health service users: Nussbaum’s capabilities approach meets values-based practice

Stenlund

2017

J Med Ethics

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This article clarifies how the freedom of thought as a human right can be understood and promoted as a right of mental health service users, especially people with psychotic disorder, by using Martha Nussbaum's capabilities approach and Fulford's and Fulford 's values-based practice. According to Nussbaum, freedom of thought seems to primarily protect the capability to think, believe and feel. This capability can be promoted in the context of mental health services by values-based practice. The article points out that both Nussbaum's approach and values-based practice recognise that people's values differ. The idea of involving different actors and service users in mental healthcare is also common in both Nussbaum's approach and values-based practice. However, there are also differences in that values-based practice relies on a 'good process' in decision-making, whereas the capabilities approach is oriented towards a 'right outcome'. However, since process and outcome are linked with each other, these two approaches do not necessarily conflict despite this difference. The article suggests that absolute rights are possible within the two approaches. It also recognises that the capabilities approach, values-based practice and human rights approach lean on liberal values and thus can be combined at least in liberal societies.

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“…But this, as Stenlund hints and others have argued,12 leaves values-based practice on the horns of a dilemma. Stenlund surmises that ‘even though values differ, it might be possible to find some shared values which could be defined as absolute rights’.…”

mentioning

confidence: 99%