Values are complex constituents of our everyday lives. For our purposes, they exist at three levels:
Foundational values more:
Foundational values are a necessary part of human survival, the importance we assign to survival itself, to security in the face of a changing and often hostile world, and human flourishing – the capacity to extend beyond the mundane through religion, art, sport, games, friendship and so on.
Committed beliefs more
We develop beliefs as individuals and communities, and often express them as axioms that sum up our commitments and our unspoken guides to action. Thus, in Australia each of us would have some commitment in relation to such issues as the public funding of health, availability of high technology medicine, immunisation, abortion or euthanasia. These attitudes will be expressed in axioms such as “High quality medical services should be available for all people”. There are differences between us, depending on our individual experiences and biographies and our cultural and economic backgrounds. Axioms provide the norms by which we conduct our lives and order our actions.
Systems and enactments more
Systems and enactments enable the expression of foundational values and norms. Different cultures have different health systems, different ethical structures, priorities for health, equity and provision of public services. Each justifies its own organisation and structure by reference to the ways in which each particular system serves the foundational values of survival, security and human flourishing.
The foundational status of the most basic values provides justification for medical and health services, and for the huge expenditure of monetary and human capital that they demand. Obvious though it may seem, understanding values in this way is essential to an appreciation of the importance of health services and explains why we spend so much on maintaining and improving them, and why they demand such high ethical standards. Because norms and axioms differ, as do cultural expectations and practices, medical practice in a pluralist society is a complicated undertaking.
The Values in Medicine website provides a summary of the themes that emerged from interviews with doctors associated with the Sydney Medical School. Prominent among their concerns were the management of the doctor-patient relationship, the use of their expert knowledge and their approach to decision-making in the best interests of their patients. They described ethical quandaries, the virtuous behaviour of colleagues and ways of improving justice and equity in health care. From all of these concerns they drew conclusions about how medical education might be improved. A review of the literature on each of these themes has led to the creation of this website as a resource for students and researchers.