Talk: "Can Values-Based Practice Cure Psychiatry?"

Amanda Evans (WashU)

Abstract: The phenomenon of conflicting values between patient and clinician poses a particular problem for psychiatry. In response, it has been argued that there is a need to integrate the perspectives and values of those who fall under the purview of psychiatry in order to improve treatment outcomes and avoid paternalistic injustice. This is precisely the goal of values-based practice (VBP), an approach developed by Bill Fulford as a counterweight to the standard of evidence-based practice in medicine. Fulford and his frequent co-author, Giovanni Stanghellini, have argued that the tools of VBP can be utilized by clinicians when value conflicts arise in the context of treating conditions such as depression, bipolar disorder, schizophrenia, and, notably, anorexia nervosa (AN). Although this strategy may initially appear promising, in this talk I will argue that VBP cannot do the work of avoiding medical paternalism in the treatment of AN. This is because the most charitable interpretations of the directive to incorporate patient values either reintroduce the sort of paternalism VBP was designed to avoid or else lead to clinical consequences many would find unacceptable and even in violation of ethical codes of conduct. Rather than dismissing this result in virtue of AN being a particularly challenging case, I will instead argue that the failure of VBP in this context cuts to the heart of limitations in rectifying medical paternalism within psychiatry as it currently exists.