Values in Professional Practice

Lessons for Health, Social Care and Other Professionals

Stephen Pattison, Roisin Pill

• Publisher: Routledge
• Year: 2020
• eBook ISBN: 9781315344843
• Edition: 1
• Topic: Medicine
• Subtopic: Architecture General

Dentists and members of the dental practice team increasingly need to know how to deal with potential risks to patients dentists staff and premises; and how to manage risk with common sense procedures. This book shows the reader how. It addresses risk issues and helps dentists and dental professionals find the answers. It is a comprehensive guide including topics such as complaints claims consent health and safety dental records radiology treatment planning and finance management. The book can be read cover to cover or referred to as needed for specific topics. Icons help guide the reader through the text and exercises for individuals and team groups are also included.

CHAPTER 1
Understanding values*

*This is a revised and expanded version of Pattison S (1998) Questioning values. Health Care Analysis. 6: 341-51. It is reproduced here with the permission of the publishers, John Wiley and Sons.

Stephen Pattison

Introduction

The language of values is ubiquitous in contemporary society. Everyone is deemed to have values, and to have a competent view on them. Prima facie, the possession of values is held to be a good thing. Value-driven organisations are thought to be admirable because of their clear convictions. Individuals who have a set of articulated values are often lauded over against others who are muddled or inarticulate about theirs. Politicians who talk up values are in vogue - so long as their lives are not lived in too flagrantly a contradictory manner to the values they commend. But what are values, and why do they command such uniform interest and respect at the present time?

I want here to problematise the notions of value and values and the uses to which these concepts are put. My working hypothesis is that the concept Values' is one of those portmanteau concepts which chases after meaning, like 'community'. It derives its popularity and legitimacy from the fact that it is an apparently simple, universally accessible concept which has a simple unexceptional primary meaning (a value is something which people value) which conceals a large number of secondary meanings and understandings. This enables people to find in it many nuances of meaning and to use it in many different ways and contexts. The notions of value and values can easily slip, chameleon-like, between users and utterances, delighting all and offending none because most people do not take the trouble to think about what they actually mean in their own lives or those of others.

Definitions of values

Having started with meanings, it is perhaps appropriate to start with the issue of definitions and then to look at synonyms for values.

The primary definition of the noun 'value' in the 1971 edition of the Oxford English Dictionary is firmly economic. The value of something is 'that amount of some commodity, medium of exchange, etc., which is considered to be equivalent of something else; a fair or adequate equivalent or return'. The verb 'to value' means 'to estimate or appraise as being worth a specified sum or amount'.

These definitions immediately prompt some observations:

1. The concept of value emerges basically from the world of economic exchange, or the market. Perhaps this is why it has come to prominence over the last 20 years.
2. The 1971 edition of the Oxford English Dictionary does not note the use of value to connote a moral context, though it does note the use of the term to evaluate persons and their merits. This suggests that the current dominant use of values in an essentially moral context is a relatively recent phenomenon. It would be interesting to know why this usage has come to prominence in this way over the last couple of decades. (It should also be noted, en passant, that while the use of 'values' to denote aspects of moral and social significance and behaviour is often dominant in contemporary usage, all values are not moral values. Thus there are aesthetic, theological and other kinds of values that play an influential part in the lives and behaviours of individuals and groups [Budd 1996]. However, it is basically the moral and social notions of values that are most in need of interrogation here.)
3. The notion of value or valuing something is relative in its very essence (Mackie 1977: 5ff). The value or estimate of something is not something fixed and objective, but transitory. Essentially, value is in the eye of the beholder, valuer or evaluator. At the core of the apparent concreteness of the notion of 'values', relativity is built in. Value and values are, then, not Platonic ideas or innate concrete realities, but rather transient and thoroughly embedded in a fluid process of change. Even those philosophers who want to assert some kind of independent objectivity for values have to concede that their development has elements of change and emergence in them (Grice 2001). It is the inner relativity obscured behind the apparent concreteness and static nature of the noun 'value' that provides the notions of value and values with much of their conceptual slipperiness. The concepts are, so to speak, thoroughly post-modern. They appear to refer to some kind of tangible external reality. However, this is illusory and they are thoroughly non-realist and at best only partially referential. Gold is only valuable to those who value gold - andthose who value gold may do so for many different reasons. The metal, being itself inanimate and an object, does not require people to value it.
4. Talk of gold brings me to thoughts of 'standards' and the way in which this particular metal is taken by many to underwrite and guarantee the economic order. A similar intrinsic and unconscious positive valuation of the concept of 'value' as worthwhile in itself seems to perform an analogous purpose within the social and moral order. If we have values then all will be well. However, as is well known, all that glitters is not gold. Gold cannot perform many important functions, for example it is not a good material for cooking with. The notion that somehow values in and of themselves will form a foundation for life and the social order is a (perhaps necessary) illusion. While illusions and faith systems may indeed be necessary for individual and social functioning, the belief in values must be recognised as just such a faith system. The reification of values to the status of pre-existent, indispensable entities is an act of human creation - or, indeed, valuation.

Synonyms for values

The foregoing preliminary observations have highlighted the relativity and conceptual slipperiness of the notions of value and values outside the economic realm. They provide a valuable framing perspective on some of the synonyms and alternative words that often seem to be used alongside or instead of the words themselves. It will be noted that some of these synonyms, substitutes and associated words are far from having the positive, desirable and solid resonances that so often surround the concept of 'values' itself.

Preferences, choices and desires

This group of words comes from the economic domain where it is thought that what people prefer, desire or choose is what they value or confer worth upon. What is preferred, desired or chosen is what people are prepared to pay for and so value. To find out what people value, one must look for what they choose and express a desire for, or more concretely, what they will pay for. It is this set of meanings that often dominates in discussion of values in the public policy arena (Aaron et al. 1994).

Attitudes and beliefs

From the psychological domain come the notions of attitude and belief. From this perspective, what people are attitudinally predisposed towards, or believe in, whether they articulate it or not, is what they value. Attitudes and beliefs, and the values that they uphold or sustain, can be discerned by watching people's behaviours, e.g. voting for a particular party in an election, as well as by asking them what they believe in or are well-disposed towards.

Norms, assumptions, expectations, judgements and prejudices

Social norms, assumptions, expectations, judgements and prejudices are the province of sociology. They are what holds people together in groups so that society is coherent and individual behaviour is to some extent predictable and conformist. Embedded in social norms, assumptions, judgements and prejudices are shared views of what is good and bad, desirable and undesirable. Interestingly, values in common parlance are often presented as desirable while assumptions are questionable! I have values - you have assumptions and prejudices. The person with values may be thought of as moral, while the person with assumptions may be perceived to be unthinking or uncritical. This is just one instance of the phenomenon of value and values being differently evaluated and perceived according to the vocabulary used.

Standards, visions and goals

The world of management and manufacturing provides the concepts of standards, visions and goals that relate closely to those of value and values. Standards are norms of what is expected and required - they make clear what sufficient value will be from the perspective of the person who creates them. Visions provide ideal standards and points of reference to which the vision creators aspire - they point to the value that the vision maker wants to create (Pattison 1997: 62ff). Between visions and standards lie more proximate goals, or specific values targets which must be reached. Again, goals point to what is worthwhile and valuable.

Morals, principles and commitments

From the domain of ethics and morality come words like morals, principles and commitment. Morals are precepts and habits that are oriented towards attaining what is good and desirable, i.e. what is valued. Principles embody values and are designed to ensure that certain values are realised. Commitments can be intellectual and/or emotional, conscious and unconscious, theoretical or enacted (Ί belong to the Conservative Party but I don't do anything for them'). They are the form of active consent to and the prosecution of values so that values are potentially concretised in some way, If one can find out what a person or group's principles and commitments are, then one has gone a good way towards identifying their values. Principles and commitments, unlike norms and prejudices, often have a halo of virtue attached to them though in fact these words are in many ways synonymous; this can be seen by substituting one set of words for the others. The real difference and distinction, which does of course exist between words, lies in matters of nuance, connotation and context surrounding particular terms and their usage in specific contexts. Thus prejudice may be regarded as more or less automatically 'blind', while commitment may implicitly be nuanced with notions of enlightenment.

There are many other terms that act as synonyms or are closely associated with values. Ideas, virtues and goods are further examples of terms that act much like values within the world of moral philosophy. Virtue is a particularly important concept in the present context. Virtues are the habits and attitudes embedded in the characters of individuals that embody the positive ends and values towards which they aspire (Crisp and Slote 1997; Pence 1991). It is by persons adopting and habitually conforming to certain values in the interest of pursuing certain visions or ends that they become habitual virtuous performers. This is a primary means whereby values and value choices become enacted and incarnated in everyday life and professional practice.

Thus, a nurse who believes in respecting all people (valued end or vision) may think communication with patients to be a vital tool to making this a reality in everyday practice (valued means). They may train themselves habitually to listen to people very carefully. If they succeed in listening they become habitually and unselfconsciously a good communicator. They thus become a virtuous communicative person within the particular aspiration of developing the positive virtue of being able to listen. This within the teleology of trying to develop and maintain respect for all.

Training in virtues allows certain values, habits and attitudes to become second nature, part of the person's essential character (Hauerwas 1981). Virtuous, value-enacting behaviour is more than a matter of following rules. Thus values become incarnated as personal and professional virtues within particular individual characters. If a person is habitually committed to negative or harmful values and enacts these from their character, they can be said to demonstrate vices (bad habits) rather than virtues (Schimmel 1997). Whether a person is deemed to be of virtuous or of vicious character, the point is that values are integrally linked to personal identity. In a sense, one cannot help being the embodiment of one's values.

Definitions of values

Enough has now been said to highlight the problematic nature of defining and understanding the meaning of value and values and to substantiate the assertion that these terms have a slippery, chameleon-like nature. This perspective is useful when approaching definitions of values such as the following:

• A value is 'something we hold dear' (Keep and McClenahan 2002: 197).
• A value is an affective disposition towards a person, object or idea.
• A value is something we recognise as good and worthwhile.
• A value is a personal belief or attitude about the truth, beauty or worth of any thought, object or behaviour.
• Values appear as attributes of things and events themselves rather than as an activity of the self or as the result of such activity of the self or as the result or such activity (Tschudin 1992: 24).

In the light of the discussion above about words, it will be recognised that many of these definitions of value and values are at best partial and often simply arbitrary and even misleading. In particular, they are heavily weighted towards what I have identified as the psychological domain and basically away from that of the sociological or economic domains. This is not necessarily very helpful in trying to gain a reasonably complete picture of what values might be in human life and language.

An interesting definition of values that appears in Tschudin's workbook on identifying and working with values comes from the author herself. It is much less limited and mysterious, while remaining intriguing, than any of those quoted above,

• Values are closely related to meaning - the meaning of life. The inner meaning of an action, an experience or an attitude gives us our values (Tschudin 1992: 2).

This definition preserves the perception that values are created by human beings and are, therefore, situated within the realm of human meanings. At the same time, it maintains a sense of the relative incomprehensibility and uncircumscribable nature of values with the notion of inner meanings. As creatures who live and breathe meanings, it is very difficult for us to stand outside them and survey them dispassionately, least of all when they concern the fundamental way in which we perceive and operate in the world. Just as we breathe air and cannot see or describe it in any very nuanced way, we mostly breathe values and meanings, assuming them rather than interrogating their nature.

What is missing explicitly in Tschudin's definition is the degree to which individuals commit themselves emotionally to values, though it can be argued that individuals are necessarily very committed to inner meanings. People certainly suffer much emotional pain when values and fundamental meanings are threatened, lost, or disparaged. A good via negativa procedure for discovering what an individual or group's basic values and meanings are is to notice or ask them what distresses them or makes them unhappy in their life and work. Here again we can note the close relationship between values and fundamental personal and professional identity.

The nature of values

The foregoing discussion reveals a wide diversity of understandings and definitions that surround the concepts of value ...

Table of contents

• Cover
• Title Page
• Copyright Page
• Contents
• Foreword
• Acknowledgements
• About the editors
• About the contributors
• Introduction
• 1 Understanding values
• 2 Understanding professions and professionals in the context of values
• Bibliography
• Index