Ethics of the everyday: using values transparency software to explore values based decision making in healthcare
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This dissertation presents discussion and analysis on values based decision making, based on a small pilot study using values transparency software, the Values Exchange, (2005). The intent is to contribute to knowledge about the essence and purpose of values based decision making and the role of values in healthcare. The literature was explored using key statements from Seedhouse (1998; 2001; 2005a), which guided exploration and discussion of the moral context of health, ethical analysis of moral issues, and the role of values and evidence in decision making. The approach, though naturalistic in philosophy, used mixed methods of data gathering, in a concurrent nested design, thus reflecting the tenet underpinning the subject of values based decision making, which is the explicit use of both values and evidence. Occupational Therapists were used as a case group to deliberate on a scenario using the process of ethical analysis afforded by the values transparency software. Fifteen community occupational therapists participated in the study. Each participant completed a pre-participation questionnaire to ascertain their views on ethically challenging situations, their understandings of ethical practice, and their expectations of participating. Next, each participant deliberated over a challenging scenario. This involved logging onto the Values Exchange secure website which had been set up for the purpose and completing ethical deliberation of the situation using the software to guide analysis. Post participation questionnaires were completed after participation using the Values Exchange with a view to noting change in views regarding ethical practice and also to assessing their experience of participating in the study. Participants’ responses were analysed using quantitative reports, which indicated trends of value-selection, and theming of the qualitative material. Views from the preparticipation and post-participation questionnaires were analysed using frequency tables and theming. Analysis also included participants’ views on using the software, information from questionnaires which they completed before and after participating, and synthesis from the literature review. The results showed disagreement among the participants regarding the course of action which the scenario proposed, and variation within the groups agreeing or disagreeing as to the case participants made to build their argument. The question of risk to the client was seen as the cause of most variation in decision making. As had been found in previous studies, for example, Barnitt and Partridge (1997), participants described the tension between practicing in a client centred way and a way that limits perceived harm to the client. A key finding arising from this study is that decision making by participants was values-based, and that in this study the software enabled that decision making to be transparent. This supports the view argued in the literature that values should be visible in decision making and part of the evidence in healthcare Haynes (2002). In addition the therapists’ deliberations highlighted a key issue, also noted in the occupational therapy literature, of the tension experienced by therapists between wanting to be client centred and achieving it when client goals conflict with therapist’s goals or recommendations. Therapists’ views on using the software are incorporated with recommendations for its future uses and other recommendations suggest strategies for practically improving the visibility of values in health care decision making. A case study methodology could well suit future exploration into the values behind decision making, and a further future study should be a philosophical analysis of therapists’ and clients’ perception of risk.