Values based practice is a radical view of the place of values in medicine which develops from a philosophical analysis of values, illness and the role of ethical principles. It denies two attractive and traditional but misguided views of medicine: that diagnosis is a merely factual matter and that the values that should guide treatment and management can be codified in principles. But, in the work of KWM Fulford, it goes further in the form (...) of a radical liberal view: that the idea of an antecedently good outcome should be replaced by that of a right process. That however leads to a dilemma as to whether it can account for its own normative status. Given that difficulty, why might one adopt the radical version? I sketch a possible motive drawing on Rorty’s rejection of authoritarianism which replaces objectivity with solidarity as the aim of judgement. But I argue that, nevertheless, this does not justify the rejection of the more modest particularist version of VBP. (shrink)

In this paper, I relate values-based practice (VBP) to clinical judgment more generally. I consider what claim, aside from the fundamental difference of facts and values, lies at the heart of VBP. Rather than, for example, construing values as subjective, I argue that it is more helpful to construe VBP as committed to the uncodifiability of value judgments. It is a form of particularism rather than principlism, but this need not deny the reality of (...) class='Hi'>values. Seen in this light, however, VBP is part of a broader conception of clinical judgment that can be compared with Kant’s conception of reflective judgment. This is a useful way of marking similarities between a number of issues raised in philosophy, which can inform a better understanding of clinical judgment. (shrink)

Values based practice is a radical view of the place of values in medicine which develops from a philosophical analysis of values, illness and the role of ethical principles. It denies two attractive and traditional views of medicine: that diagnosis is a merely factual matter and that the values that should guide treatment and management can be codified in principles. But it goes further in the adoption of a radical liberal view: that right or (...) good outcome should be replaced by right process. I describe each of these three claims but caution against the third. (shrink)

This paper attempts to show how certain approaches in Values Based Practice duplicate key moves in liberal political theory.

This article sets out a manifesto for the development of an international values-based practice fully engaged with the diversity of cultural values and implemented through the resources of the international movement in philosophy and psychiatry. Anticipated by mid-twentieth century ordinary language philosophy of the “Oxford School,” the last three decades have witnessed a remarkable flowering of cross-disciplinary work between philosophy and psychiatry. The article indicates the scope and scale of this work and then describes the emergence (...) of contemporary values-based practice as its philosophy-into-practice cutting edge. Values-based practice although originating in philosophy and psychiatry is currently being developed mainly in areas of bodily medicine such as surgery. As such, it has been criticized for focusing, as contemporary health care has largely focused, on the individual at the expense of cultural values. Hence arises the need for extending values-based practice internationally. The resources available from international philosophy and psychiatry for so extending values-based practice are outlined and some of the challenges are indicated. The article concludes with the hope that psychiatry in supporting the development of international values-based practice will by the same token take poll position in the development of contemporary science-led clinical care. (shrink)

Discusses values from the perspective of different health care professionals and why teams and collaborations may succeed or fail.

This article clarifies how the freedom of thought as a human right can be understood and promoted as a right of mental health service users, especially people with psychotic disorder, by using Martha Nussbaum’s capabilities approach and Fulford’s and Fulford _et al_’s values-based practice. According to Nussbaum, freedom of thought seems to primarily protect the capability to think, believe and feel. This capability can be promoted in the context of mental health services by values-based (...) class='Hi'>practice. The article points out that both Nussbaum’s approach and values-based practice recognise that people’s values differ. The idea of involving different actors and service users in mental healthcare is also common in both Nussbaum’s approach and values-based practice. However, there are also differences in that values-based practice relies on a ‘good process’ in decision-making, whereas the capabilities approach is oriented towards a ‘right outcome’. However, since process and outcome are linked with each other, these two approaches do not necessarily conflict despite this difference. The article suggests that absolute rights are possible within the two approaches. It also recognises that the capabilities approach, values-based practice and human rights approach lean on liberal values and thus can be combined at least in liberal societies. (shrink)

This article clarifies how the freedom of thought as a human right can be understood and promoted as a right of mental health service users, especially people with psychotic disorder, by using Martha Nussbaum’s capabilities approach and Fulford’s and Fulford et al ’s values-based practice. According to Nussbaum, freedom of thought seems to primarily protect the capability to think, believe and feel. This capability can be promoted in the context of mental health services by values-based (...) practice. The article points out that both Nussbaum’s approach and values-based practice recognise that people’s values differ. The idea of involving different actors and service users in mental healthcare is also common in both Nussbaum’s approach and values-based practice. However, there are also differences in that values-based practice relies on a ‘good process’ in decision-making, whereas the capabilities approach is oriented towards a ‘right outcome’. However, since process and outcome are linked with each other, these two approaches do not necessarily conflict despite this difference. The article suggests that absolute rights are possible within the two approaches. It also recognises that the capabilities approach, values-based practice and human rights approach lean on liberal values and thus can be combined at least in liberal societies. (shrink)

A models-based approach has been advocated as a means of overcoming the serious limitations of the traditional approach to physical education. One of the difficulties with this approach is that physical educators have sought to use it to achieve diverse and sometimes competing educational benefits, and these wide-ranging aspirations are rarely if ever achieved. Models-based practice offers a possible resolution to these problems by limiting the range of learning outcomes, subject matter and teaching strategies appropriate to each (...) pedagogical model and thus the arguments that can be used for educational value. In this article, two examples are provided to support a case for educational value. This case is built on an examination of one established pedagogical model, Sport Education, which is informed by a perspective on ethics. Next, I consider Physical Literacy which, I suggest, is an existentialist philosophical perspective that could form the basis of a new pedagogical model. It is argued, in conclusion, that a models-based approach along with a reconstructed notion of educational value may offer a possible future for physical education that is well grounded in various philosophical arguments and the means to facilitate a wide range of diverse individual and social educational ?goods? (shrink)

When bringing philosophical attention to bear on social movement slogans in general, philosophers have often focused on their communicative nature—particularly the hermeneutical failures that arise in discourse. Some of the most popular of these failures are illustrated in ‘all lives matter’ retorts to ‘black lives matter’ pronouncements. Although highlighting and criticizing these failures provides much needed insight into social movement slogans as a communicative practice, I claim that in doing so, philosophers and slogans’ users risk placing too much importance (...) on outgroup understandings. This emphasis is misguided because gaining such uptake is not required of particular slogans to perform their functions; indeed it is an inherent risk of them. I show how such an emphasis can also be distracting to users. Since social movement slogans that express values are first and foremost for users, I argue for a shift in focus in what these slogans (such as ‘Black Is Beautiful’ and the more recent ‘Black Lives Matter’) do for users, as well as what they demand from users and enable them to express. When slogans have done these things, regardless of uptake, we can say they have performed one of their key functions. (shrink)

Nowadays ethics plays a vital role in numerous professions. Due to social requirements and technical advances, changes in the accreditation rules in legal, economic, medical and engineering education have emerged in many countries, often requiring the inclusion of an ethics requirement in such professional programmes. In this work, the authors demonstrate that such changes are absolutely necessary in the legal profession in Lithuania. Specifically, the record low level of prestige of the judiciary and lawyers in the Lithuanian society and the (...) fact that lawyers are often accused of legal nihilism, clannish behaviour, and protectionism, demand that legal ethics assumes a far greater role in Lithuanian legal education. It is necessary to stress that the topic of lawyers’ ethical violations and the consequences of such violations is discussed in the society in only in a fragmentary, and not transparent manner; moreover, the significance of ethics in the education and training of lawyers has not been properly evaluated either. Especially having in mind Lithuania’s Soviet heritage (during most of the Communist era there was almost no education on those issues), it becomes obvious that legal ethics must be continuously stressed in the legal profession’s education and development. The importance and relevance of this topic is primarily determined by the current evaluation of lawyers in Lithuania, which shows that lawyers do not fulfil the expectations of the society. This raises a question whether law graduates indeed acquire this system of ethical values as part of the process of obtaining the knowledge and skills that are necessary for a modern lawyer. While analysing the Lithuanian legal documents governing the requirements for legal studies, it has been noticed that a course in legal ethics or lawyer’s professional responsibility is not compulsory either in the qualification requirements for judges, or in the Ruling of the Constitutional Court of 20 February 2008 on legal education for those who want to assume the position of a judge according to the order of law. In the description of legal study programmes, courses on professional ethics are designated as an optional non-legal subject, which is quite different from the legal education systems of other countries, where this type of course is compulsory for future lawyers. Even if this course is taught at Lithuanian higher education establishments, it is limited to the analysis of cases and legal regulation. Insufficient attention to this issue obviously creates the erroneous impression that it is of secondary importance for a lawyer. It should be noted that legal ethical standards, the development of lawyers’ value systems and other problematic questions related to legal ethics have not attracted attention of the Lithuanian scholars either. Therefore, this is a question of the utmost importance for legal education and requires additional research. In global educational and other academic literature, much is being discussed about the methods of teaching ethics, and the place of ethical subjects in study programmes and assessment. It is well worth supporting the research on the development of lawyers’ value systems, in that the lack of such values may influence the evaluation of the practicing lawyers’ satisfaction with their job, self-confidence and belief in the importance of their profession. Obtaining social-ethical attitudes and perspectives helps future lawyers gain more trust in their professional identity and the correctness of their professional work. The main conclusions drawn from the research are the following: (1) the university can and needs to contribute to the development of students’ value systems and this is one of the most important content requirements within the legal study programmes; (2) while teaching ethics, the primary focus must be not on the legal acts regulating ethics, which are changing over time, but on the aim of helping that students themselves have an increased sense of selfawareness and sensitivity to ethical issues in law practice, recognise and understand ethical dilemmas arising in the law, recognise the dominant attitudes in the society towards the role of a lawyer and motivate them to reconsider and discuss the value bases of such attitudes and their change; (3) a course on legal ethics – no matter how perfect it would be – is not the only way to develop a personal value system. In this context, the importance of liberal arts education should be accentuated. Given the research conducted, there is a clear link between the development of moral awareness and the person’s education in general. (shrink)

There are emotively powerful words that can modify our judgment, arouse our emotions, and influence our decisions. The purpose of this paper is to provide instruments for analyzing the structure of the reasoning underlying the inferences that they trigger, in order to investigate their reasonableness conditions and their persuasive effect. The analysis of the mechanism of persuasion triggered by such words involves the complex systematic relationship between values, decisions, and emotions, and the reasoning mechanisms that have been investigated under (...) the label of “heuristics.” On the one hand, arguing using ethical words is shown to sometimes involve value-based practical reasoning grounded on evaluative classifications stemming from hierarchies of values and maxims of experience. On the other hand, ethical words provide representations bound to the interlocutor’s experiences and judgments, which trigger specific emotions yielding a particular reaction. This chain of judgments and reactions and the potential fallaciousness thereof can be inquired into by examining the relationship between the heuristic processes of reasoning and the more complex argumentative structure that the use of such words involves. The analysis of the 2013 Italian political campaign and the ad hominem arguments used by the political candidates shows the different strategies and counterstrategies for the manipulation of emotions. (shrink)

In this paper, I explore one line of argument for the Humean Theory of Reasons, the view that all normative reasons are based on desires. Then, I suggest a way to block that argument inspired by Aquinas’s discussions on choice, will, and indeterminacy of reason alone.

From the perspective of values-based practice, there is much of interest in Lorenzo Gilardi and Giovanni Stanghellini's "I am a Schizophrenic." Their dialogue exhibits many of the key elements of VBP, it exemplifies the particular challenges presented by VBP in mental health, it illustrates the power of phenomenology in meeting these challenges, and it points by extension to an insight into contemporary psychiatry's professional identity as a medical profession.VBP is a resource for working with values—with what (...) matters or is important to those concerned—in healthcare. Avoiding preset answers, it offers instead a process that supports those concerned in a given situation... (shrink)

The purpose of this article is to introduce a model of value-based leadership. The model is based on tensions among values, interests, and power ; and tensions that take place within and among citizens, workers, and leaders. The VIP-CWL model describes the forces at play in the promotion of value-based practice and formulates recommendations for value-based leadership. The ability to enact certain values is conditioned by power and personal interests of communities, workers, and (...) leaders of organizations. People experience internal conflicts related to VIP as well as external conflicts related to disagreements with the CWL. Value-based practice is predicated on the ability to alleviate these tensions. Leaders have 4 main roles in promoting value-based practice: clarify values, promote personal harmony among VIP, enhance congruence of VIP among CWL, and confront people and groups subverting values or abusing power to promote personal interests. (shrink)

The cross-cultural literature is reviewed and integrated together with attitude theories, thereby outlining a model through which certain values influence the intervening variables that ultimately lead managers to tolerate employee bribery. The case of Latin America is employed to illustrate how regionally dominant cultural values may shape managers' attitudes, subjective norms, and perceived behavioral control, which in turn affect tolerance of employee bribery. A series of research propositions and practical recommendations are derived from the model.

According to an attractive and widely held view, all practical reasons are explained in terms of the (instrumental or final) value of the action supported by the reason. I argue that this theory is incompatible with plausible assumptions about the practical reasons that correspond to certain moral rights, including the right to a promised action and the right to an exclusive use of one’s property. The argument is an explanatory rather than extensional one: while the actions supported by the relevant (...) reasons (e.g. keeping a valid promise or respecting property) can be argued to have a certain kind of value, I argue that this value presupposes a moral right, and therefore cannot explain the reason. Reflection on such cases suggest the conclusion that reasons that are subject to normative powers are generally not value-based. This also has important implications for the dialectic between ‘value-first’ and ‘reasons-first’ approaches to normativity. (shrink)

Ethics have taken a center stage in business curriculum development over the past 5 years. Sustainable business practices are an important issue when it comes to adequately educating the next generation of marketing professionals. A variety of approaches in how to achieve such goals have been proposed as ideal methodologies. This paper presents a case study on curriculum development for a study abroad trip in Cambodia for marketing students. Furthermore, this article represents one method to incorporate the role of NGOs (...) in international business into business ethics courses. Results show that values-based curriculum serve as an appropriate learning pedagogy for the advancement of ethics in business educational scenarios. Through the use of values-based format, results demonstrate that when students are presented in constructive ethical situations it induces critical self-reflection necessary for more effective ethics education. Furthermore, with the additional cross-cultural component of the research design, students were also exposed to ethics as a component of culture. The current study extends both the pedagogy and ontological development and application of ethics education, specifically, the values-based curriculum providing a pragmatic approach to ethics teachings, and also presents an empirical study of how to integrate NGOs into international business educational platforms. (shrink)

In this paper, I discuss practical reasons and value, assuming a coexistence thesis according to which reasons and value always go together. I start by doing some taxonomy, distinguishing among three different ways of accounting for the relation between practical reasons and the good. I argue that, of these views, the most plausible one is that according to which something’s being good just consists in how certain facts about the thing in question – other than that of how it is (...) good – give us reasons to want it. It has been argued that this reasons-based account of goodness is open to various counter-examples. I consider a few, and argue that they misfire. (shrink)

South Korean industrial conglomerates (chaebols) are discussed in the context of value-based management (VBM). Recent economics and finance literature on the diversion of corporate resources from the firm to the controlling shareholders (tunneling), for which chaebols are notoriously known, is discussed. Chaebols have engaged in empire building and expropriation of minority shareholders, distorting the process of efficient resource allocation in South Korea, and became the root cause of the 1997 financial crisis. We argue that the 1997 crisis should be (...) viewed as a consequence of chaebols’ systematic deviation from the guiding principles of VBM. We use tunneling within chaebols as an example of the need to directly address prohibition of the expropriation of minority shareholders as a primary postulate of VBM. We argue that VBM should require that the value generated by the firm not be expropriated from minorities, or any stakeholders, by dominant shareholders. We also examine moral and ethical considerations and present explanations as to why the unethical practice of tunneling has been tolerated by the South Korean public. We show that public opinion on tunneling is changing and that the treatment of minority shareholders by chaebols’ controlling families is becoming increasingly unacceptable to South Koreans. (shrink)

There are emotively powerful words that can modify our judgment, arouse our emotions and influence our decisions. This paper shows how the use of emotive meaning in argumentation can be explained by showing how their logical dimension, which can be analysed using argumentation schemes, combines with heuristic processes triggered by emotions. Arguing with emotive words is shown to use value-based practical reasoning grounded on hierarchies of values and maxims of experience for evaluative classification.

There is an increasing need for norms to be embedded in technology as the widespread deployment of applications such as autonomous driving, warfare and big data analysis for crime fighting and counter-terrorism becomes ever closer. Current approaches to norms in multi-agent systems tend either to simply make prohibited actions unavailable, or to provide a set of rules which the agent is obliged to follow, either as part of its design or to avoid sanctions and punishments. In this paper we argue (...) for the position that agents should be equipped with the ability to reason about a system’s norms, by reasoning about the social and moral values that norms are designed to serve; that is, perform the sort of moral reasoning we expect of humans. In particular we highlight the need for such reasoning when circumstances are such that the rules should arguably be broken, so that the reasoning can guide agents in deciding whether to comply with the norms and, if violation is desirable, how best to violate them. One approach to enabling this is to make use of an argumentation scheme based on values and designed for practical reasoning: arguments for and against actions are generated using this scheme and agents choose between actions based on their preferences over these values. Moral reasoning then requires that agents have an acceptable set of values and an acceptable ordering on their values. We first discuss how this approach can be used to think about and justify norms in general, and then discuss how this reasoning can be used to think about when norms should be violated, and the form this violation should take. We illustrate how value based reasoning can be used to decide when and how to violate a norm using a road traffic example. We also briefly consider what makes an ordering on values acceptable, and how such an ordering might be determined. (shrink)

Values-based recruitment is used in England to select healthcare staff, trainees and students on the basis that their values align with those stated in the Constitution of the UK National Health Service. However, it is unclear whether the extensive body of existing literature within the field of moral philosophy was taken into account when developing these values. Although most values have a long historical tradition, a tendency to assume that they have just been invented, and (...) to approach them uncritically, exists within the healthcare sector. Reflection is necessary. We are of the opinion that selected virtue ethics writings, which are underpinned by historical literature as well as practical analysis of the healthcare professions, provide a helpful framework for evaluation of the NHS Constitution values, to determine whether gaps exist and improvements can be made. Based on this evaluation, we argue that the definitions of certain NHS Constitution values are ambiguous. In addition to this, we argue that ’integrity' and ’practical wisdom', two important concepts in the virtue ethics literature, are not sufficiently represented within the NHS Constitution values. We believe that the NHS Constitution values could be strengthened by providing clearer definitions, and by integrating ’integrity' and ’practical wisdom'. This will benefit values-based recruitment strategies. Should healthcare policy-makers in other countries wish to develop a similar values-based recruitment framework, we advise that they proceed reflectively, and take previously published virtue ethics literature into consideration. (shrink)

The idea that professional practices such as education should be based upon or at least be informed by evidence continues to capture the imagination of many politicians, policy makers, practitioners and researchers. There is growing evidence of the influence of this line of thought. At the same time there is a growing body of work that has raised fundamental questions about the feasibility of the idea of evidence-based or evidence-informed practice. In this paper I make a further (...) contribution to this discussion through an analysis of a number of assumptions that inform the discussion. I focus on the epistemological, ontological and praxeological dimensions of the discussion and in each domain identify a deficit. In the epistemological domain there is a knowledge deficit, in the ontological domain an effectiveness or efficacy deficit and in the practice domain an application deficit. Taken together these deficits not only raise some important questions about the very idea of evidence-based practice but also highlight the role of normativity, power and values. Against this background I outline the case for the idea of value-based education as an alternative for evidence-based education. As I am generally concerned about the expectations policy makers hold about what evidence can and should achieve in professional practices such as education, my contribution is primarily meant to provide educators and other professionals with arguments that can help them to resist unwarranted expectations about the role of evidence in their practices and even more so of unwarranted interventions in their practices. (shrink)

Innovative healthcare technologies may raise ethical concerns which prevent their implementation for fear of unexpected or undesirable outcomes, even before they are introduced into usual clinical practice. Essential to innovation is therefore to analyze benefits and drawbacks from a multidisciplinary point of view (i.e., biomedical, social, financial). Value-based healthcare is currently the most comprehensive theoretical framework to evaluate the benefits of healthcare technologies on patients and society in the longer term. Technically, “the systematic evaluation of properties, effects and/or (...) impacts of health technologies” must be performed by validated procedures of Health Technology Assessment (HTA), supported by early HTA procedures to retrieve preliminary evidence and expert opinions. The aim of this study is to perform an early HTA of germline editing technologies in order to estimate their impact on patients and society, in light of the recent, controversial debate which followed the germline gene editing of human embryos. (shrink)

Some moral theories, such as objective forms of consequentialism, seem to fail to be practically useful: they are of little to no help in trying to decide what to do. Even if we do not think this constitutes a fatal flaw in such theories, we may nonetheless agree that being practically useful does make a moral theory a better theory, or so some have suggested. In this paper, I assess whether the uncontroversial respect in which a moral theory can be (...) claimed to be better if it is practically useful can provide a ground worth taking into account for believing one theory rather than another. I argue that this is not the case. The upshot is that if there is a sound objection to theories such as objective consequentialism that is based on considerations of practical usefulness, the objection requires that it is established that the truth about what we morally ought to do cannot be epistemically inaccessible to us. The value of practical usefulness has no bearing on the issue. (shrink)

Owner/client is a significant contributing party within the management of a project in construction. In addition to the payment of the bills related to the project, owner/client has duties and responsibilities such as selecting the professionals, making his requirements understood clearly by other parties, making decisions to recommendations and placing orders. Owner/client has to perform these duties and responsibilities at the right times and in correct ways to have the required quality and value for his/her investment. In performing his/her duties (...) and responsibilities owner could introduce positive and negative contributions to the value of the constructed facility. Value-based project management concerns with owner's/client's value system and helps owner/client in performing his/her duties and responsibilities for the optimum positive contributions to the value of the constructed facility in construction. This paper highlights the principles of value-based project management in construction and investigates the impact of owner contributions to the value of a constructed facility in practice. (shrink)

The agroecological transition of agriculture not only requires changes in practices but also in ways of thinking and in their underlying values. Agroecology proposes broad scientific principles that need to be adapted to the singularities of each farm. This contextualization leads to the identification of agroecological practices that work locally and could serve as evidence-based practices to be transferred to local practitioners. This strategy was tested in a 4-year experiment conducted with dairy-sheep farmers in the South of France. (...) The aim was to collectively engage in the agroecological transition. Our work focused on the creation of a diagnostic tool that was used to analyze local farms and identify virtuous practices to be promoted locally as evidence-based practices. But this strategy came up against the complexity and singularity of the situations to be transformed: not only was no evidence found but the construction of the diagnostic tool itself led to controversy concerning the models of agriculture to be promoted. The experiment then took a pragmatic turn: on-farm workshops were organized to enable farmers to benefit from the professional judgment of peer farmers who were willing to help their colleagues accomplish their agroecological transition. The diagnostic tool, which was designed to be prescriptive, was then used to judge the social acceptability of solutions that made sense in each farmer’s own situation. Our experiment led us to conclude that managing the agro-ecological transition of farmers and their farming system is better conceived as a value-based process than as an evidence-based one. (shrink)

As the second decade of the twenty-first century begins, political leaders across Western Europe have increasingly pointed to Muslims' bodily attitudes as indicative of their refusal to join the wider society, and as indicative of the failure of the society to sufficiently carry out programs of political socialization and assimilation. Among the targeted practices have been covering the hair or face , wearing loose, short trousers , refusing to shake hands with those of the opposite sex, and praying in the (...) street . Political actors have made both broader and more specific claims: that these badges of separation show that some Muslims refuse the rules of common social life, and that covering the hair or face shows that the oppression of women, either in particular cases or generally, remains part of Islamic culture. Civic "normality" is thereby portrayed against images of its opposite: people who by their bodily practices show themselves to be visibly and slavishly obedient, unmodern, and sectarian. I examine here how politically useful condemnations have been given the force of law in France. In particular, I trace a shift in the legal justifications for French laws and decisions targeting women's dress during the first decade of the 2000s. The shift, to be found in texts of court decisions and administrative practice, consists in moving from harm-based arguments to values-based ones. (shrink)

A number of ethical frameworks have been proposed to support decision-making in public health and the evaluation of public health policy and practice. This is encouraging, since ethical considerations are of paramount importance in health policy. However, these frameworks have various deficiencies, in part because they incorporate substantial ethical positions. In this article, we discuss and criticise a framework developed by James Childress and Ruth Bernheim, which we consider to be the state of the art in the field. Their (...) framework distinguishes aims, such as the promotion of public health, from constraints on the pursuit of those aims, such as the requirement to avoid limitations to liberty, or the requirement to be impartial. We show how this structure creates both theoretical and practical problems. We then go on to present and defend a more practical framework, one that is neutral in avoiding precommitment to particular values and how they ought to be weighted. We believe ethics is at the very heart of such weightings and our framework is developed to reflect this belief. It is therefore both pluralist and value-based. We compare our new framework to Childress and Bernheim’s and outline its advantages. It is justified by its impetus to consider a wide range of alternatives and its tendency to direct decisions towards the best alternatives, as well as by the information provided by the ranking of alternatives and transparent explication of the judgements that motivate this ranking. The new framework presented should be useful to decision-makers in public health, as well as being a means to stimulate further reflection on the role of ethics in public health. (shrink)