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Improving ethics analysis in health technology assessment

Published online by Cambridge University Press:  25 January 2011

Katherine Duthie  and
Kenneth Bond
Katherine Duthie
Affiliation:
University of Alberta and Royal Alexandra Hospital
Kenneth Bond
Affiliation:
Institute of Health Economics
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Abstract

Objectives: The aim of this study was to critically examine the current guidance for conducting ethics analysis in health technology assessment (HTA) and to offer recommendations for how to improve this practice.

Methods: MEDLINE, Philosopher's Index, and Google Scholar were searched for articles and reports using the keywords “ethics” and “health technology assessment” and related terms. Bibliographies of all relevant articles were also examined for additional references. A philosophical analysis of the existing guidance was conducted.

Results: We offer three recommendations for improving ethics analysis in HTA. First, ethical and legal issues must be clearly separated so that all policy-relevant questions that the technology raises can be considered clearly and systematically. Second, analysts must make better use of ethics theory and discuss better how particular theoretical approaches and associated analytic tools are selected to make transparent which alternative approaches were considered and why they were rejected. Third, the necessity for philosophical expertise to adequately conduct ethics analysis needs to be acknowledged.

Conclusions: To act on these recommendations for ethics analysis, we offer these three steps forward: acknowledge and use relevant expertise, further develop models for conducting and reporting ethics analyses, and make use of untapped resources in the literature.

Keywords

Health technology assessmentEthical analysisBioethicsNormative ethics
Type
METHODS
Information
International Journal of Technology Assessment in Health Care , Volume 27 , Issue 1 , January 2011 , pp. 64 - 70
Copyright
Copyright © Cambridge University Press 2011

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References

REFERENCES

1. Baylis, F, Robert, JS. The inevitability of genetic enhancement technologies. Bioethics. 2004;18:1–26.CrossRefGoogle ScholarPubMed
2. Benatar, D. Bioethics and health and human rights: A critical review. J Med Ethics. 2006;32:17–20.CrossRefGoogle Scholar
3. Busse, R, Orvain, J, Velasco, M, et al. Best practice in undertaking and reporting health technology assessments. Int J Technol Assess Health Care. 2002;18:361–422.CrossRefGoogle Scholar
4. CADTH. Report requirements for health technology assessment, version 2. Ottawa: Canadian Agency for Drugs and Technologies in Health; 2008.Google Scholar
5. Daniels, N. Wide reflective equilibrium and theory acceptance in ethics. J Philos. 1979;76:256–282.CrossRefGoogle Scholar
6. DeJean, D, Giacomini, M, Schwartz, L, Miller, FA. Ethics in Canadian health technology assessment: A descriptive review. Int J Technol Assess Health Care. 2009;25:463–469.CrossRefGoogle ScholarPubMed
7. Drummond, M, Jefferson, T. Guidelines for authors and peer reviewers of economic submissions to the BMJ. The BMJ Economic Evaluation Working Party. BMJ. 1996;313:275–383.CrossRefGoogle Scholar
8. EUnetHTA. HTA core model for medical and surgical interventions, v1.0r. Work Package 4. Helsinki: Finnish Office for HTA; 2008. http://www.eunethta.net/upload/WP4/Final%20Deliverables/HTA%20Core%20Model%20for%20Medical%20and%20Surgical%20Interventions%201%200r.pdfGoogle Scholar
9. Gallo, P. Integrating ethical enquiry and health technology assessment: Limits and opportunities for efficiency and equity. Poiesis & Prax. 2004;2:103–117.CrossRefGoogle Scholar
10. Hailey, D, Jacobs, P, Ries, N, et al. Reprocessing of single-use medical devices: Clinical, economic, and health services impact [Technology report number 105]. Ottawa: Canadian Agency for Drugs and Technologies in Health; 2008.Google Scholar
11. Heitman, E. Ethical issues in technology assessment. Conceptual categories and procedural considerations. Int J Technol Assess Health Care. 1998;14:544–566.CrossRefGoogle ScholarPubMed
12. Hofmann, B. Why ethics should be part of health technology assessment. Int J Technol Assess Health Care. 2008;24:423–429.CrossRefGoogle ScholarPubMed
13. Hofmann, B. Toward a procedure for integrating moral issues in health technology assessment. Int J Technol Assess Health Care. 2005;21:312–318.CrossRefGoogle Scholar
14. Hofmann, B. Is there a technological imperative in health care? Int J Technol Assess Health Care. 2002;18:675–689.CrossRefGoogle Scholar
15. INAHTA Ethics Working Group. INAHTA's working group on handling ethical issues, Final report. 2005. http://www.inahta.org/upload/Final%20report%20Ethics%20in%20HTA%20Nov%2007.pdfGoogle Scholar
16. INAHTA. Survey on handling ethical issues. 2003. http://www.inahta.org/upload/About%20INAHTA/Survey_ethical_issues_results_web.pdfGoogle Scholar
17. Lehoux, P, Williams-Jones, B. Mapping the integration of social and ethical issues in health technology assessment. Int J Technol Assess Health Care. 2007;23:9–16.CrossRefGoogle ScholarPubMed
18. Lehoux, P, Tailliez, S, Denis, J-L, Hivon, M. Redefining health technology assessment in Canada: Diversification of products and contextualization of findings. Int J Technol Assess Health Care. 2004;20:325–336.CrossRefGoogle ScholarPubMed
19. Liberati, A, Altman, DG, Tetzlaff, J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: Explanation and elaboration. PLoS Med. 2009;6:e1000100.CrossRefGoogle ScholarPubMed
20. Molewijk, AC, Stiggelbout, AM, Otten, W, Dupuis, HM, Kievet, J. Implicit normativity in evidence-based medicine: A plea for integrated empirical ethics research. Health Care Anal. 2003;11:69–92.CrossRefGoogle ScholarPubMed
21. Moreno, JD. Ethics by committee: The moral authority of consensus. J Med Philos. 1988;13:432.CrossRefGoogle Scholar
22. Potter, BK, Avard, D, Graham, ID, et al. Guidance for considering ethical, legal, and social issues in health technology assessment: Application to genetic screening. Int J Technol Assess Health Care. 2008;24:412–422.CrossRefGoogle ScholarPubMed
23. Saarni, S, Hofmann, B, Lampe, K, et al. Ethical analysis to improve decision-making on health technologies. Bull World Health Org. 2008;86:617–623.CrossRefGoogle ScholarPubMed
24. Schleidgen, S, Jungert, MC, Bauer, RH. Mission: Impossible? On empirical-normative collaboration in ethical reasoning. Ethic Theory Moral Prac. 2010;13:59–71.CrossRefGoogle Scholar
25. Solomon, MZ. Realizing bioethics' goals in practice: Ten ways “is” can help “ought”. Hastings Cent Rep. 2005;35:40–47.Google Scholar
26. Taylor, PW. Principles of ethics: An introduction. Belmont, CA: Wadsworth Publishing Co; 1975.Google Scholar
27. ten Have, H. Ethical perspectives on health technology assessment. Int J Technol Assess Health Care. 2004;20:71–76.CrossRefGoogle ScholarPubMed
28. Veatch, RM. The roles of scientific and normative expertise in public policy formation: The anthrax vaccine case. In: Rasmussen, L, ed. Ethics expertise: History, contemporary perspectives, and applications. Netherlands: Springer; 2005:211–225.CrossRefGoogle Scholar
29. Weinstein, BD. What is an expert? Theor Med. 1993;14:57–73.CrossRefGoogle ScholarPubMed