Justification des pratiques et clinique fondée sur les valeurs

The scientific approach of health care is currently overlooked by evidence-based medicine. However, the practice of evidence-based medicine raises some difficulties within care environments where decision-making involves many actors with values that may be very different. Value-based practice, developed by K.W.M. Fulford, offers some tools to support decision-making that builds on the values of all the individuals involved. This framework, a partner of evidence-based practice, is particularly relevant for the social care institutions where disabled people often stay for the lifetime. Values-based practice can back up decision-making that: (1) takes into account the expectations of all the stakeholders (patients, carers and clinicians), (2) benefits from the ressources of an extended multidisciplinary team (the variety of the professional backgrounds is a decisive asset to elicit the relevant values), (3) is genuinely person-centered, by starting from the awareness of the unique values of each individual involved. Decision-making in values-based practice is essentially a process that explores by “dissensus” the whole wealth of the values in play. In this way, this framework allows to implement thoroughly the basic intuitions that today underly the daily teamwork in institutions for disabled people. Indeed, such environments offer some rich models to “link science with people”.