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Table 1 VBHC’s monistic account of ‘value’ neglects patients’ pluralistic, personal values in life

From: Value based competition in health care’s ethical drawbacks and the need for a values-driven approach

Ms. B, a 64-year old artist, was referred to a psychiatrist, Dr K. She had a history of occasional but increasingly disruptive episodes of hypomania. They decide to start on a course of lithium. Their decision was mainly based on clinical effectiveness, cost, and potential adverse side-effects respectively. Yet, after a few weeks, that decision turned out to have been wrong. That is, judged by her values as an artist. She explained that she did not really have a problem with the lithium, and that her mood had indeed been more stable. The problem she experienced was that she could no longer “see colors”. Colors had lost their emotional intensity, which, for her as an artist, was a disaster. Had her need to be able to ‘really see’ colors been more apparent at the time, then the evidence of lithium’s ‘emotional blunting’ effects would probably have been discussed at that stage. Ms. B. might still have decided to start on lithium but she would have been aware of the possibility of this side effect and her doctor would have been aware of the fact that this was a major concern to her.
  1. Case based on: Fulford, K. W. M., 2008. Values-Based Practice: A New Partner to Evidence-Based Practice and A First for Psychiatry? Mens Sana Monographs 6(1):2,3