A consideration of both means and ends : values based medicine and the problem of changing values

Values-based medicine (VBM) represents the most influential and sophisticated attempt to theorize the place of values within medical practice. It responds to competing value perspectives through a balancing procedure, termed “dissensus,” which seeks to keep multiple values in play. We argue, however, that VBM focuses on a static and cross-sectional picture of values, and does not provide an account of how values may change over time. We promote reasoning about values as an additional means of resolving conflicts within health care, which can manage dynamic values. We advocate for Hilary Putnam’s influential conception of the entanglement of fact and value to form the theoretical basis for values reasoning, which could operate alongside the balancing procedures advocated by VBM.