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  • Print publication year: 2014
  • Online publication date: October 2014

4 - Valuing outcomes


Values are what we care about. As such, values should be the driving force for our decision making. They should be the basis for the time and effort we spend thinking about decisions. But this is not the way it is. It is not even close to the way it is.

Ralph Keeney


Value judgments underlie virtually all clinical decisions. Sometimes the decision rests on a comparison of probability alone, such as the probability of surviving an acute episode of illness. In such cases, there is a single outcome measure – the probability of immediate survival – that can be averaged out to arrive at an optimal decision. In most cases, however, decisions between alternative strategies require not only estimates of the probabilities of the associated outcomes, but also value judgments about how to weigh the benefits versus the harms, and how to incorporate other factors like individual preferences for convenience, timing, who makes decisions, who else is affected by the decision, and the like. Consider the following examples.

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