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European Sociological Review 15:405-430 1999
© 1999 Oxford University Press
research-article |
Do Values Matter?
An Analysis of Advance Directives for Medical Treatment
Department of Sociology, University of Washington Seattle, WA 98195-3340. Tel. 206-543-5582; fax +206-543-2516; e-mail: hechter{at}u.washington.edu.
Arizona Cancer Center, P.O. Box 245024, Tucson, AZ 85721. Tel: +520-626-3118; fax: +520-626-2284
Department of Sociology, New York University 269 Mercer Street, 4th Floor, New York, NY 10003-0831. Tel: +212-998-8368; fax: +212-995-4140;e-mail:gj1{at}is3.nyu.edu.
Department of Sociology, Louisiana State University Baton Rouge, LA 70803-5411. Tel: +225-388-5029; fax: +225-388-5102
One of the oldest disputes in social science divides objectivists and subjectivists. Whereas subjectivists recognize the causal importance of internal states, such as individual values, objectivists forswear them in favour of exclusively external causes, such as social structural constraints. Their reluctance to countenance internal states stems in large part from the perception that effective measures of values and other internal states are extremely difficult to find. Lacking such measures, there is no means of disentangling subjective and objective factors in behavioural explanations. This paper presents a framework employing the factorial survey method that yields rigorous measures of individual values and that enables assessment of the operation of both objective and subjective factors in human behaviour. As test site for the new framework, we examine the formulation of advance directives for medical treatment (living wills) among a sample of healthy elderly people. We construct hypothetical scenarios depicting a life-threatening situation and ask respondents to indicate their desire for medical intervention given differing circumstances: the intervention's chance of success, various levels of chronic pain, limitation of physical function, burden to family and friends, and the pecuniary cost of the prospective treatment. Analysing the data with a variety of statistical tools, we obtain measures of four values and unbiased estimates of their effects on treatment decisions, as well as estimates of the effects of objective factors on both values and treatment decisions
Manuscript received: May 1, 1998.
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