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Protected Values
Protected values or other very similar notions, such as sacred values, taboo values, and moral mandates, are values people preclude from tradeoffs with other values, particularly secular values. Protected values refer to any concrete or abstract entity (e.g., human beings, animals, dignity, health, love, honor, honesty, human rights) an individual or a community considers as infinitely significant, not substitutable and inviolable, and therefore as nontradable and noncompensatory. For instance, many people think that it is morally wrong to sacrifice human or animal lives in return for monetary benefits or to have a free market of transplant organs. Trading them off would offend deeply held beliefs and undercut people's self-image as moral beings or threaten a way of life.
An important foundation for research on this issue has been laid by Philip Tetlock and colleagues. They have examined how people respond to and cope with violations of protected values or sacred values. Other research efforts, mainly influenced by Ilana Ritov and Jonathan Baron, have focused more on how such values affect decision-making processes.
Relevance for Medical Decision Making
The phenomenon of protected values is interesting for theoretical and practical reasons. From a theoretical perspective, protected values create a problem for utilitarian theories. Such models presuppose that any value can be traded off for any other value. When protected values are involved, however, trading off such values is precluded. Researchers have recognized trade-off reluctance as a common problem when using contingent valuation methods to quantify values or public goods. For example, people often reject decisions and refuse “putting a price on life” by trading off life with monetary expenses. It seems that if goods or services tap ethical issues or reflect a protected value, placing a monetary value on this specific value is difficult yet unacceptable.
From a practical perspective, protected values are highly relevant for medical decision making. Ethical reservations or strong protected values are very likely involved in fields such as euthanasia, prolongation of life, abortion, prenatal diagnosis, vaccination, organ transplantation, genetic therapy, and cloning. Given that such decisions tap into strong beliefs and moral commitments, they are highly emotion laden. Research suggests that people can respond with strong outrage to threats to protected values and socially distance them selves from potential violators of taboo trade-offs. Furthermore, interactions between physicians and patients can become exceedingly difficult and con flicting when protected values are involved on one or both sides.
Research and Current Findings
Omission and Action Tendencies
Previous research suggests that protected values are often linked with deontological principles. Deontology refers to duty and is usually contrasted with consequentialism. The distinctive idea of deontological reasoning is that the focus is on the inherent rightness or wrongness of an act per se rather than on the magnitude of the consequences (the consequentialist perspective). Deontological principles reflect morally mandated actions or omissions, such as the duty to keep promises or the duty not to lie. Such duties can be religious in nature (e.g., the Ten Commandments), socially contracted (e.g., the Hippocratic Oath, human rights), or intuitive (e.g., to do no harm).
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- Basis for Making the Decision
- Acceptability Curves and Confidence Ellipses
- Beneficence
- Bioethics
- Choice Theories
- Construction of Values
- Cost-Benefit Analysis
- Cost-Comparison Analysis
- Cost-Consequence Analysis
- Cost-Effectiveness Analysis
- Cost-Minimization Analysis
- Cost-Utility Analysis
- Decision Quality
- Distributive Justice
- Dominance
- Equity
- Evaluating Consequences
- Expected Utility Theory
- Expected Value of Perfect Information
- Extended Dominance
- Health Production Function
- League Tables for Incremental Cost-Effectivenes: Ratios
- Marginal or Incremental Analysis, Cost-Effectiveness Ratio
- Monetary Value
- Moral Choice and Public Policy
- Net Benefit Regression
- Net Monetary Benefit
- Nonexpected Utility Theories
- Pharmacoeconomics
- Protected Values
- Rank-Dependent Utility Theory
- Return on Investment
- Risk-Benefit Trade-Off
- Subjective Expected Utility Theory
- Toss-Ups and Close Calls
- Value-Based Insurance Design
- Welfare, Welfarism, and Extrawelfarism
- Biostatistics and Clinical Epidemiology
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- Bayes's Theorem
- Bayesian Analysis
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- Bias
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- Causal Inference and Diagrams
- Causal Inference in Medical Decision Making
- Conditional Independence
- Conditional Probability
- Confidence Intervals
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- Cox Proportional Hazards Regression
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- Variance and Covariance
- Violations of Probability Theory
- Weighted Least Squares
- Decision Analysis and Related Mathematical Models
- Applied Decision Analysis
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- Decision Tree: Introduction
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- Decision Trees: Sensitivity Analysis, Basic and Probabilistic
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- Declining Exponential Approximation of Life Expectancy
- Deterministic Analysis
- Discrete-Event Simulation
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- Expected Value of Sample Information, Net Benefit of Sampling
- Influence Diagrams
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- Markov Models, Cycles
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- Test-Treatment Threshold
- Time Horizon
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- Health Outcomes and Measurement
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- Cost-Identification Analysis
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- Costs, Opportunity
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- Health Status Measurement, Construct Validity
- Health Status Measurement, Face and Content Validity
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- Health Status Measurement, Minimal Clinically Significant Differences, and Anchor Versus Distribution Methods
- Health Status Measurement, Reliability and Internal Consistency
- Health Status Measurement, Responsiveness and Sensitivity to Change
- Human Capital Approach
- Life Expectancy
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- Oncology Health-Related Quality of Life Assessment
- Outcomes Research
- Patient Satisfaction
- Regret
- Report Cards, Hospitals and Physicians
- Risk Adjustment of Outcomes
- SF-36 and SF-12 Health Surveys
- SF-6D
- Sickness Impact Profile
- Sunk Costs
- Impact or Weight or Utility of the Possible Outcomes
- Certainty Equivalent
- Chained Gamble
- Conjoint Analysis
- Contingent Valuation
- Cost Measurement Methods
- Decomposed Measurement
- Disability-Adjusted Life Years (DALYs)
- Discounting
- Discrete Choice
- Disutility
- EuroQol (EQ-5D)
- Health Utilities Index Mark 2 and 3 (HUI2, HUI3)
- Healthy Years Equivalents
- Holistic Measurement
- Multi-Attribute Utility Theory
- Person Trade-Off
- Quality of Well-Being Scale
- Quality-Adjusted Life Years (QALYs)
- Quality-Adjusted Time Without Symptoms or Toxicity (Q-TWiST)
- SMARTS and SMARTER
- Split Choice
- Utilities for Joint Health States
- Utility Assessment Techniques
- Willingness to Pay
- Other Techniques, Theories, and Tools
- Artificial Neural Networks
- Bayesian Networks
- Bioinformatics
- Chaos Theory
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- Complexity
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- Constraint Theory
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- Decisional Conflict
- Error and Human Factors Analyses
- Ethnographic Methods
- Expert Systems
- Patient Decision Aids
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- Story-Based Decision Making
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- Threshold Technique
- Perspective of the Decision Maker
- Advance Directives and End-of-Life Decision Making
- Consumer-Directed Health Plans
- Cultural Issues
- Data Quality
- Decision Making in Advanced Disease
- Decisions Faced by Hospital Ethics Committees
- Decisions Faced by Institutional Review Boards
- Decisions Faced by Nongovernment Payers of Healthcare: Managed Care
- Decisions Faced by Patients: Primary Care
- Decisions Faced by Surrogates or Proxies for the Patient, Durable Power of Attorney
- Diagnostic Process, Making a Diagnosis
- Differential Diagnosis
- Evaluating and Integrating Research Into Clinical Practice
- Evidence Synthesis
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- Expert Opinion
- Genetic Testing
- Government Perspective, General Healthcare
- Government Perspective, Informed Policy Choice
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- Health Insurance Portability and Accountability Act Privacy Rule
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- Informed Consent
- Informed Decision Making
- International Differences in Healthcare Systems
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- Medicaid
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- Medicare
- Models of Physician–Patient Relationship
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- Physician Estimates of Prognosis
- Rationing
- Religious Factors
- Shared Decision Making
- Surrogate Decision Making
- Teaching Diagnostic Clinical Reasoning
- Technology Assessments
- Terminating Treatment, Physician Perspective
- Treatment Choices
- Trust in Healthcare
- The Psychology Underlying Decision Making
- Accountability
- Allais Paradox
- Associative Thinking
- Attention Limits
- Attraction Effect
- Automatic Thinking
- Axioms
- Biases in Human Prediction
- Bounded Rationality and Emotions
- Certainty Effect
- Cognitive Psychology and Processes
- Coincidence
- Computational Limitations
- Confirmation Bias
- Conflicts of Interest and Evidence-Based Clinical Medicine
- Conjunction Probability Error
- Context Effects
- Contextual Error
- Counterfactual Thinking
- Cues
- Decision Making and Affect
- Decision Modes
- Decision Psychology
- Decision Weights
- Decision-Making Competence, Aging and Mental Status
- Deliberation and Choice Processes
- Developmental Theories
- Dual-Process Theory
- Dynamic Decision Making
- Editing, Segregation of Prospects
- Emotion and Choice
- Errors in Clinical Reasoning
- Experience and Evaluations
- Fear
- Frequency Estimation
- Fuzzy-Trace Theory
- Gain/Loss Framing Effects
- Gambles
- Hedonic Prediction and Relativism
- Heuristics
- Human Cognitive Systems
- Information Integration Theory
- Intuition Versus Analysis
- Irrational Persistence in Belief
- Judgment
- Judgment Modes
- Learning and Memory in Medical Training
- Lens Model
- Lottery
- Managing Variability and Uncertainty
- Memory Reconstruction
- Mental Accounting
- Minerva-DM
- Mood Effects
- Moral Factors
- Motivation
- Numeracy
- Overinclusive Thinking
- Pain
- Pattern Recognition
- Personality, Choices
- Preference Reversals
- Probability Errors
- Probability, Verbal Expressions of
- Problem Solving
- Procedural Invariance and Its Violations
- Prospect Theory
- Range-Frequency Theory
- Risk Attitude
- Risk Aversion
- Risk Communication
- Risk Perception
- Scaling
- Social Factors
- Social Judgment Theory
- Stigma Susceptibility
- Support Theory
- Uncertainty in Medical Decisions
- Unreliability of Memory
- Value Functions in Domains of Gains and Losses
- Worldviews
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