An aside: I have now taken to stressing to mental health nursing students at UCLan that there is an ambiguity in the spoken label: values based practice. So ‘values based practice’ is any approach to healthcare that takes appropriate note of the role of values (as one of my students suggested last week). By contrast ‘Values Based Practice’ is a proprietary brand of this promoted by Bill Fulford. That is why there can even be books critical of the very idea of VBP but not vbp. Mentioning this, today, Bill seemed rather amused by the distinction.
The opposing requirements on a conception of values based practice concern the imperative to get the philosophy right versus the need to encourage approaches which do not result in the danger of paternalism. Stressing the latter justifies Bill Fulford in resisting the allure of moral particularism. Stressing the former motivates philosophers – like me - to criticise VBP’s proceduralism from the perspective of moral particularism. Today, however, hard opposition was put aside and some peripheral issues explored.
Criticising my own papers on idiographic understanding (for the wrong reasons, I still think), Anna Berquvist made an interesting suggestion. We should think of vbp as containing an idiographic element as present in the way that a patient or service user’s reports of their circumstances and wishes / values constitute a claim about the world (understood in the broad way moral particularists understand ‘world’). Deploying a phrase to remind us of Charles Travis, she described these as ‘answerable stances’ and suggested that – following Travis – identifying the stance they are and the alternatives they rule out calls for a specific focus on that person (she didn’t say but probably meant sotto voce: and occasion).
Further, she suggested that this called for narrative understanding. Echoing this back in a question, I asked whether she meant that the gap between the general context-independent meanings of words and the particular claims they can be used to mean on particular lips on particular occasions (thus framing an answerable stance) was meant to be filled by narrative and if so, why stringing words together in narratives answered this problem (by contrast with missing it altogether if narratives are words with meanings in general; or begging the question if narratives are words on the understandings presented by the occasion). Sadly we ran out of time for a proper discussion of this point. And, in truth, my own paper (based on this) also faced the awkwardness of the narrative theorists dilemma: either ubiquitous but vacuous or specific but rare.