**3.1 Patients' rights**

*Neuroethics in Principle and Praxis - Conceptual Foundations*

unreplaceable input for their patient care.

taken for patients' management (**Figure 1**).

*The concept of values-based medicine (VsBM): patient is the center of care.*

management.

*management".*

ished autonomy, as well as dealing with end-of-life situations.

**2. Definition and the concept of values-based medicine**

sick, or disabled relatives, over socialization and commercialization of traditional household tasks, to substitute decision-making for minors and patients with dimin-

The nature of neurosurgical problems forces neurosurgeons to face their patients' families in different emotional situations, frustrated to see good results, disappointed with the outcome, confused, denying, or angry. Neurosurgeons should learn the skill to absorb the first reaction of the patients' family and work with them as one team to help their loved one. The patient's family can play a very positive part in the caregiving team for the patient and may have a great and

Values-based medicine (VsBM) is the concept to ensure that the principles of medical ethics are strictly implemented and observed in every step of a patient's

*Values-based medicine can be defined as "medical practice that aims at maximizing value, specifically desirable or positive value in every step of a patient's medical* 

The concept of values-based medicine (VsBM) stresses on the fact that patient, patient care, and well-being are the center of care in modern medicine. The treating neurosurgeons, physicians, or healthcare givers should spare no effort to improve their skills, update their knowledge, and learn to use the latest technology in order to provide the best care for the patient. The treating team should have a vision and build up a strategy of management and follow-up of their patients. All these necessary steps should be performed within a frame of values and medical ethics. The treating teams should respect and observe the patient and value and respect the culture of the society. Evidence-based medicine should be considered an important component of values-based medicine [1].The key elements of values-based medicine which, like evidence-based medicine, influence any clinical decisions may be

**62**

**Figure 1.**

The respect of patients' rights is one of the main foundations of the concept of values-based medicine. Patients should be considered as partners and share in the process of management. Patients should agree and consent to every step of treatment. Patients have the right to be fairly and properly treated; follow-up should be guaranteed. A patient's privacy, dignity, and confidentiality should be respected. Dignity encompasses a feeling of self-worth and equality. It is paramount that the patient be treated as a person with a disease, rather than a disease that a person has. The patient should also feel he is an equal partner in decision-making, and not just a bystander or subordinate. Patients should be educated and learn about their medical problems, treatment options, and the prognosis. Patients must know who the treating team is, their experiences and qualifications. Patients should have the right to complain in the cases of dissatisfaction about the treatment or lack of communication. Most of these rights are illustrated in **Figure 3**. These fundamental human rights are listed in the WHO recommendation [2] and the World Federation of Neurological Societies as good practice guideline [3].

## **3.2 The duties and task of the treating teams**

The concept of values-based medicine draws the outlines of the duties and tasks of the treating team as illustrated in **Figure 4**. These duties include respecting the


**Figure 2.** *The principles of medical ethics.*

**Figure 3.** *The Patient's rights.*

**65**

*Values-Based Medicine (VsBM) and Evidence-Based Medicine (EBM)*

patient and preserving their dignity. It is the duty of every doctor to improve skills and update the knowledge. Doctors should research answers to previously unanswered medical questions. Doctors should be good citizens and advocate for good

Healthcare is considered as a universal human right. Culture, faith, socioeconomic factors, and the perception of the value of the education, work, and status of doctors in differing societies are some of the causes of the variance of healthcare in those societies. That variance cannot be deemed as right or wrong, which led to the study and introduction of ethical relativism. Ethical relativism is the view that there are no ethical standards that are absolutely true and must be applied to the societies, without variance. According to the Relativism Theory, a certain event, attitude, or practice may be considered right, if it is accepted as morally correct by the people of the involved society. The same event or attitude may be considered wrong by a

Throughout the world, most neurosurgical training programs are designed to produce safe, effective neurosurgeons trained to find evidence for the treatment of

Neurosurgeons are obliged to establish ethical and professional relationships with their patients and to that end, should listen to and be guided by both the patient's medical complaint and their perception of the possible outcomes. It is the duty of neurosurgeons to explain to their patients all the steps of investigation,

The neurosurgeon can gain valuable knowledge of the patient's culture and beliefs while discussing the benefits and risks of a particular method of management during the course of obtaining informed consent. This knowledge and exchange of information assist in gaining the patient's respect and trust and compliance for both the agreed-upon treatment and its follow-up. Ethical informed consent requires that autonomy and beneficence are applied in equal measure. In applying beneficence, at the expense of autonomy, neurosurgeons may cause irreparable psychological damage [5–7] . Pressure or influence for a particular course of treatment can never be considered ethical, because, although it may be

**5. Evidence-based medicine (EBM) and values-based medicine (VsBM)/**

An "evidence" is considered as evidence according to data of a particular cohort

Ross defined the clinical evidence as "In essence, evidence—narrowly defined or not—is a provisional departure point in the consideration of whether or not a particular course of action is to be taken in any clinical context." [9] This definition directly links the evidence to its application but not to the strength, validity, and

study under particular condition of some patient group somewhere. Several scholars and ethicists have raised concern about using the stereotype of evidence to promote a chosen type of therapy or surgery [8]. This attitude may cause bias in

selecting evidence to justify certain methods of treatment.

applying the principle of beneficence, it is at the expense of autonomy.

health. They should maintain a high level of professionalism at all times.

*DOI: http://dx.doi.org/10.5772/intechopen.88393*

society that does not accept it as morally correct.

different neurosurgical problems [4].

**EBM and VsBM**

**5.1 What is medical evidence?**

reliability of the source of that evidence.

treatment, operation, and possible outcome.

**4. Ethical relativism**

**Figure 4.** *The tasks and duties of a medical team.*

patient and preserving their dignity. It is the duty of every doctor to improve skills and update the knowledge. Doctors should research answers to previously unanswered medical questions. Doctors should be good citizens and advocate for good health. They should maintain a high level of professionalism at all times.
