A Better Grounding for Person-Centered Medicine?

Response—Forty-Seven Years Later: Further Studies in Disappointment?

“…While there are still important debates about their precise interpretation and application in particular contexts (more on this shortly), there is a growing consensus that ideas including values-based practice, person-centred care, narrative medicine, holistic (or "humanistic" or "personalized") medicine, shared decision-making, patient expertise, and phenomenology cannot be treated simply as "fine ideals" or "ethical add-ons" to sound scientific clinical practice (Loughlin 2020, 20). Rather, many would now contend, they represent essential components of any credible account of the nature and value of clinical interventions because, as Little and his colleagues have consistently argued, medicine needs to be evaluated as a social practice, with reference to a proper understanding of its role in securing basic human values, contributing to the survival and flourishing of real people, in all of their specificity and diversity (Little et al 2012;Little 2013Little , 2014.It is with characteristic modesty that Little has commented that his approach was "unlikely to Abstract This paper provides a commentary on "Vascular amputees: A study in disappointment" (Little et al 1974) and its significance in the development of the disability rights movement, as well as the movements for values-based medicine and personcentred health and social care.…”

“…There is a massive overlap between the goals of these movements, with their shared interest in grounding the value of medicine in the promotion of human flourishing and in more specific points including the need to incorporate such ideas as phronesis, virtue ethics, and virtue epistemology in our thinking about practitioner education (Little et al 2011). Little expresses his support for Entwistle and Watt's defence of person-centred care, praising in particular its emphasis on situating persons in their social contexts and its associated conception of relational autonomy (Little 2013;Entwistle and Watt 2013).…”

“…While this might initially seem an easy way to rebut medical paternalism, a position that collapses into ethical subjectivism pulls "the inferential rug from under itself" (Loughlin and Miles 2015, 157), as the paternalist can simply respond that paternalism is "my way of doing things." So while, as Little recognizes, this is not a reason to abandon PCC, he is right to note that that more work needs to be done on how precisely to interpret and apply the language of PCC in a range of controversial cases (Little 2013).…”