The framework of VBP is structured around a 10-principles backbone (Fulford, K.W.M. Ten Principles of Values-Based Medicine. The Philosophy of Psychiatry: A Companion. Ch. 14. J. Radden. New York, Oxford University Press, 2004, 205 - 234)

The Philosophy

1: All decisions stand on two feet, on values as well as on facts, including decisions about diagnosis (the "two feet" principle)

2: We tend to notice values only when they are diverse or conflicting and hence are likely to be problematic (the "squeaky wheel" principle)

3: Scientific progress, in opening up choices, is increasingly bringing the full diversity of human values into play in all areas of healthcare (the "science-driven" principle)

The Policy

4: VBP's "first call" for information is the perspective of the patient or patient group concerned in a given decision (the "patient perspective" principle)

5: In VBP, conflicts of values are resolved primarily not by reference to a rule prescribing a "right" outcome, but by processes designed to support a balance of legitimately different perspectives (the "multi-perspective" principle)

The Practice Skills

6: Careful attention to language use in a given context is one of a range of powerful methods for raising awareness of values (the "values blindness" principle)

7: A rich resource of both empirical and philosophical methods is available for improving our knowledge of other people’s values (the "values myopia" principle)

8: Ethical reasoning is employed in VBP primarily to explore differences of values, not, as in quasi-legal bioethics, to determine "what is right" (the "space of values" principle)

9: In VBP communication skills have a substantive rather than (as in quasi-legal ethics) a merely executive role in clinical decision making (the "how it’s done" principle)

A New Alliance

10: VBP, although involving a partnership with ethicists and lawyers (equivalent to the partnership with scientists and statisticians in EBM), puts decision making back where it belongs, with users and providers at the clinical coal-face (the "who decides" principle)