Name your values before a health decision, because a pros-and-cons list isn’t enough

Key takeaways

• When Penn researchers interviewed 180 seriously ill hospital patients, more than half rated living on a breathing machine as bad as or worse than death, while answers varied widely from person to person.
• In six experiments with about 6,700 adults, pros-and-cons lists made people feel less torn but didn’t help them pick the option that matched what they cared about.
• A 2024 Cochrane review of 209 studies found that decision aids probably help people make choices that match their values.
• Across 144 tests, a brief self-affirmation exercise, such as writing about a personal value, made people slightly more open to health messages, though a large school-based replication of a values exercise found no effect.
• A simple grid that scores each option against your top values shows which choice fits your life better than a list can.

Medicine often treats one outcome as the main event: whether you live. A team at the University of Pennsylvania asked seriously ill patients a different question.

Between July 2015 and March 2016, the researchers interviewed 180 hospitalized patients, all 60 or older, with serious illnesses¹². They asked how various health states would compare with death.

More than half said relying on a breathing machine to live would be as bad as dying or worse². A similar share felt that way about losing control of their bladder and bowels². Being bedbound or confused all the time also ranked that low for many patients, but answers varied widely from one person to the next¹.

Other patients lean the opposite way. In a 2010 survey of 237 mostly Latino patients at a large urban safety-net hospital, people were generally willing to accept life-sustaining treatment that could leave them bedbound or in a vegetative state, even when the odds of recovery were very low¹⁴.

Neither group is wrong. They hold different values. That’s the core lesson of this article: the “best” health choice depends partly on facts and partly on what you care about most.

For people drawn to natural health, that’s familiar ground. Many choices about food, remedies and care are values choices: purity, independence, tradition, caring for the earth, family. Below, we cover what research says about naming those values, using them to decide, and handling the moments when they collide.

Your values are the reasons beneath your choices

Psychologists describe values as broad goals that guide choices across many situations. The best-known framework comes from Shalom Schwartz, a psychologist at the Hebrew University of Jerusalem. His theory names 10 basic values, with support from studies in 82 countries³.

Several of them will sound familiar to natural-health readers⁴:

• Self-direction: independence in what you think and do.
• Tradition: keeping the customs and ways handed down from the past.
• Benevolence and universalism: concern for the welfare of other people.
• Security: protecting yourself and keeping life orderly and stable.

Schwartz arranges the values in a circle that captures which ones fit together and which ones clash³⁴. Values on opposite sides pull against each other, such as openness to change versus keeping things as they are⁴. That’s why some health decisions feel like a tug-of-war inside you.

Most groups rank values in a similar order on average, but individuals differ a lot³. So a list can start the conversation. Your own words matter more. If “purity” or “living close to the land” is how you’d say it, use that.

Our article on why people turn to natural health found that fitting one’s values is a main reason people choose it. This article is about using those values on purpose.

A pros-and-cons list feels helpful but misses the point

When a decision gets hard, most of us reach for a pros-and-cons list. Researchers who build medical decision tools do too.

In 2016, a team led by researcher Holly Witteman reviewed 110 published articles describing 98 tools meant to help people clarify their values⁵. Pros-and-cons lists were the most common kind⁵. Most tools didn’t let users add concerns of their own, and few showed how each option lined up with what the user cared about⁵.

Then the team tested 11 strategies in six online experiments with about 6,700 U.S. adults⁶. Everyone faced the same made-up medical decision.

The results were surprising. Pros-and-cons lists and rating scales made people feel less torn, but they didn’t help people choose the option that matched their own values⁶. What did help were tools that calculated and showed people which option fit what mattered to them⁶.

The authors warned that feeling settled isn’t the same as choosing well⁶. You can feel calm about a choice that doesn’t fit you.

A 2021 update pooled randomized trials of values tools from 33 articles⁷. Tools that asked people to work through their values cut choices that clashed with those values by about 4 percentage points⁷. They also modestly eased the feeling of being torn⁷. Much of the evidence came from hypothetical decisions, so the authors urged some caution⁷.

The takeaway: don’t just list good and bad points. Score each option against the things you care about, then look at which one comes out on top.

Decision aids help people choose what fits them

A decision aid is a booklet, video or online tool that lays out your options, their likely benefits and harms, and asks what matters to you.

In 2024, Cochrane, an international network known for careful evidence reviews, pooled 209 studies involving 107,698 adults facing 71 different decisions⁸. People using decision aids probably made more choices that matched what they valued most, a finding rated moderate certainty⁸. They were also less unsure about their own values, with high certainty⁸.

They didn’t report more regret later, and an aid used during a visit added about a minute and a half⁸. Our articles on patient freedom and on shared decision-making cover these tools in more depth.

If no decision aid exists for your choice, a general one can help. The Ottawa Hospital Research Institute offers a free two-page Ottawa Personal Decision Guide in 16 language versions⁹. A companion version lets two people fill it out side by side⁹. The institute notes that these guides don’t meet every standard for a full decision aid⁹.

Only you can define a good outcome

The Penn study shows why values belong in medical choices. For many seriously ill patients, some kinds of survival felt no better than death¹².

The researchers urged caution. Most patients weren’t living in those states, and people often misjudge how they’ll feel in a future they haven’t experienced¹. Still, the team argued that doctors and researchers should pay attention to outcomes other than death, because many seriously ill patients may find certain kinds of disability intolerable¹.

Values also shift. A Yale study found that older adults’ treatment preferences changed over time. They grew more willing to accept treatments that risked physical disability than ones that risked mental decline¹⁵. What you’d choose at 50 may differ from what you’d choose at 80.

That’s why it helps to say your priorities out loud, to your family and your clinician, and to revisit them. A good outcome for you might be living as long as possible. It might be staying at home, staying clear-headed or staying able to garden. Only you can rank those.

Reflecting on values can ease defensiveness and steady hard feelings

Hard health news often stings because it seems to threaten who we are. A warning about drinking, or advice to take a medicine, can feel like a judgment on your choices.

Psychologists have tested a simple fix called self-affirmation. Before reading a health message, people write briefly about a value or quality that matters to them. The idea is that feeling secure in who you are makes threatening news easier to take in.

A 2015 analysis led by Tracy Epton of the University of Manchester pooled 144 experimental tests¹⁰. Self-affirmation slightly increased acceptance of health messages, intentions to change and later behavior¹⁰. The effects were small but consistent¹⁰.

Writing about a personal value produced the strongest effects¹¹. The tool also worked better when the health risk felt close and personally relevant¹¹.

There’s a caution. A related values-writing exercise was tested in middle schools, where an earlier large study had found academic benefits. A well-powered 2017 repeat in the same setting, using the same steps, found no sign of an effect¹².

The authors called the technique fragile when used widely¹². That study was about schoolwork, not health, but it’s a reason not to oversell self-affirmation.

Values also sit at the center of acceptance and commitment therapy, or ACT. This form of talk therapy helps people make room for painful thoughts and feelings while taking steps toward what matters to them. A 2020 review of 20 meta-analyses covering 12,477 people found ACT effective for anxiety, depression, substance use and pain¹³. It generally beat waitlists and usual care, though not cognitive behavioral therapy, another well-tested talk therapy¹³.

When your values pull in different directions

Some of the hardest health choices pit one value against another. Schwartz’s circle predicts which pairs will clash: values that favor independence and change sit across from values that favor safety, custom and fitting in⁴.

Conflict	What it can look like	A question that helps
Independence vs. family	You want to handle a diagnosis your way. Your adult children are scared.	“What is each of us most afraid will happen?”
Purity vs. safety	You avoid drugs, but your blood pressure keeps rising.	“What does avoiding drugs protect for me, and which option protects that best over the next 10 years?”
Tradition vs. new evidence	A family remedy conflicts with a test result.	“Can I honor the tradition without leaning on it for this problem?”
Caring for the earth vs. cost	Organic and local food strains the budget.	“Where does my money do the most good for my health and my values?”

Three habits help. First, name both values out loud instead of arguing about the decision itself. Second, look for an option that serves both, even partly. Third, set a date to revisit the choice, so neither value has to lose forever.

For family conflicts, the Ottawa guide for two lets each person mark what matters most on the same page⁹. Our articles on family health disagreements offer scripts for those talks.

Sort your values, then score your options

This worksheet turns the research into a tool. It follows the finding that people choose better when they can see how each option matches their values, not just list pros and cons⁶.

1. Circle your values. From this list, circle the five that matter most for this decision: purity, independence, tradition, faith, family, caring for the earth, safety, living long, staying active, clear thinking, comfort, simplicity, saving money, honesty, time with loved ones. Add any of your own.
2. Weight them. Give your top value 3 points, the next two 2 points each, and the last two 1 point each.
3. List your real options. Include “wait and watch” if your clinician says it’s safe. Get the facts on each option’s benefits and risks from your clinician or a decision aid.
4. Score each option. For each value, rate how well the option serves it: 0 (not at all), 1 (somewhat) or 2 (well).
5. Multiply and add. Multiply each score by the value’s weight, then total each option.
6. Do a gut check. If the winner feels wrong, a value is probably missing. Add it and score again.
7. Bring it to your appointment. Ask: “Which option best protects my top value?”

This is a worked example. Picture a hypothetical reader we’ll call Sam, who has knee arthritis and three options from his clinician.

Sam’s value (weight)	Physical therapy program	Steroid shot	Pain relievers as needed
Independence (3)	2	1	1
Few drugs (2)	2	0	1
Time with grandkids (2)	1	2	1
Saving money (1)	1	1	2
Staying active (1)	2	1	1
Weighted total	15	9	10

These are Sam’s personal ratings of fit, not measures of how well each treatment works. The grid tells him which option suits his values. His clinician helps him judge whether it suits his knee.

What the evidence shows

Claim	What studies found	Evidence level
Decision aids reduce uncertainty about what matters to you	209 studies; less uncertainty about values, high certainty; probably more values-matching choices, moderate certainty8	Strong evidence
Explicit values tools reduce choices that clash with values	33 articles; about 4 points fewer clashing choices; mostly hypothetical decisions7	Promising but early
Pros-and-cons lists improve values-matching choices	Eased conflict but didn’t improve fit in six experiments with a made-up decision6	Evidence says no
Self-affirmation makes health messages easier to accept	144 tests; small effects; a school replication of a values exercise found none1012	Promising but early
ACT helps anxiety, depression, substance use and pain	20 meta-analyses, 12,477 people13	Strong evidence
Most seriously ill patients rate some disabilities as worse than death	Over half did at one hospital, with wide variation; another hospital’s patients leaned the other way214	Promising but early

Natural health is a values practice, and evidence can serve it

People who choose natural health are sometimes written off as simply misinformed. The research points somewhere kinder. Many are acting on values they hold deeply, the same way people who prefer high-tech medicine are acting on theirs.

Values do one job and evidence does another. Values tell you which outcomes matter: staying independent, keeping your body free of what you don’t need, being there for your family. Evidence tells you which option is most likely to deliver those outcomes.

Trouble starts when one tries to do the other’s job. A value can’t tell you whether an herb lowers blood pressure. A study can’t tell you whether you’d rather have more time or more comfort. Use both, and your choices become your own.

Questions readers ask

The bottom line

Every health choice blends facts with values. Research suggests that naming your values and seeing how each option serves them leads to choices that fit your life better than a simple pros-and-cons list.

Write down what matters most, score your options against it, and bring that page to your clinician. Your values tell you where you want to go. Good evidence helps you find the road that gets you there.

Related reading

• Most people turn to natural health because it fits their values
• When expert advice deserves weight, now that patients have the right to decide
• How medical decisions are supposed to get made with you
• Most family health disagreements can wait, but a few can’t
• What to ask when your doctor recommends a treatment

Sources

1. Penn Center for Health Incentives and Behavioral Economics. “What do hospitalized patients say would be worse than death?” (on Rubin EB, Buehler AE, Halpern SD, JAMA Internal Medicine research letter, 2016). University of Pennsylvania, 2016. chibe.upenn.edu
2. The Pennsylvania Gazette. “Worse than death” study of seriously ill inpatients. University of Pennsylvania, November 2016. thepenngazette.com
3. Schwartz SH. “An Overview of the Schwartz Theory of Basic Values.” Online Readings in Psychology and Culture, 2012. scholarworks.gvsu.edu
4. Schwartz SH. “Understanding values: Schwartz theory of basic values.” Integration and Implementation Insights, 2022. i2insights.org
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7. Witteman HO, Ndjaboue R, Vaisson G, et al. “Clarifying Values: An Updated and Expanded Systematic Review and Meta-Analysis.” Medical Decision Making, 2021. cris.maastrichtuniversity.nl (limitations as stated in the medRxiv preprint: medrxiv.org)
8. Stacey D, et al. “Decision aids for people facing health treatment or screening decisions.” Cochrane Database of Systematic Reviews, 2024 (plain-language summary). cochrane.org
9. Ottawa Hospital Research Institute, Patient Decision Aids Research Group. “Ottawa Personal Decision Guide.” OHRI, updated August 2026. decisionaid.ohri.ca
10. Epton T, Harris PR, Kane R, van Koningsbruggen GM, Sheeran P. “The Impact of Self-Affirmation on Health-Behavior Change: A Meta-Analysis.” Health Psychology, 2015. research.manchester.ac.uk
11. Epton T. “Self-affirmation changes health behavior.” Society for Personality and Social Psychology, Character & Context blog, June 2015. spsp.org
12. Hanselman P, Rozek CS, Grigg J, Borman GD. “New evidence on self-affirmation effects and theorized sources of heterogeneity from large-scale replications.” Journal of Educational Psychology, 2017. profiles.wustl.edu
13. Gloster AT, Walder N, Levin ME, Twohig MP, Karekla M. “The empirical status of acceptance and commitment therapy: A review of meta-analyses.” Journal of Contextual Behavioral Science, 2020. edoc.unibas.ch
14. Stone SC, Mohanty SA, McClung CD. “Treatment Preferences: Impact of Risk and Benefit in Decision Making.” Journal of Palliative Medicine, 2010. pubmed.ncbi.nlm.nih.gov
15. Yale University. “Treatment Preferences for End-of-Life Care Changes With Time and Declining Health.” Yale News, April 26, 2006. news.yale.edu