Ethical analysis of the change of values in healthcare.

What people value today can differ from what they have valued. But what does this value variability mean in the context of healthcare? We ethically analyze the current state of research on the change of embedded values in healthcare systems and the driving processes behind it. Starting with a systematic literature review and a content analysis, we subject the selected articles to an ethical analysis through three ethical theories: principlism, value ethics, and utilitarianism. The included papers demonstrated how moral dissonance between individual values and behavior leads to moral distress. The occurrence of moral distress was related to current healthcare practices. Beneficence and non-maleficence played a central role where principlism was considered, virtue ethics was criticized for not addressing the structural problems in the healthcare system, and consequences of value change for healthcare professionals and the society were analyzed. Further, principlism cannot fully cover the value change in medical care with its top-down and bottom-up processes leading to consequences for the patients, healthcare professionals, and society as a whole. We found correlations between top-down value change processes in the healthcare system and the quality of care. Health professionals are forced to develop an attitude that does not adhere to traditional medical values any longer and eventually leads to low-value care. Accompanying phenomena like moral distress cause dropout of healthcare workers. These can be hardly slowed down from the bottom-up by the development of resilience and moral courage. More effectively, structural changes through value interventions have the potential to improve working conditions and the quality of care.