Hostname: page-component-cd9895bd7-q99xh Total loading time: 0 Render date: 2024-12-25T06:01:22.408Z Has data issue: false hasContentIssue false
  • English
  • Français

Why ethics should be part of health technology assessment

Published online by Cambridge University Press:  01 October 2008

Bjørn Morten Hofmann
Bjørn Morten Hofmann*
Affiliation:
University College of Gjøvik, Faculty for Health, Care Nursing, Norwegian Knowledge Centre for the Health Service, and Section for Medical Ethics, University of Oslo
Get access Rights & Permissions [Opens in a new window]

Abstract

From the heydays of HTA in the 1970s, it has been argued that ethics should be a part of HTA. Despite more than 30 years with repeated intentions, only few HTA reports include ethical analysis, and there is little agreement on methods for integrating ethics. This poses the question of why it is so important to integrate ethics in HTA? The article analyzes ten arguments for making ethics part of HTA. The validity of the arguments depend on what we mean by “integrating,” “ethics,” and “HTA.” Some of the counterarguments explain why it has taken so long to integrate ethics in HTA and why there are so many ethical approaches. Nevertheless, some of the arguments for making ethics part of HTA appear to be compelling. Health care is a moral endeavor, and the vast potential of technology poses complex moral challenges. A thorough assessment of technology would include reflection on these moral aspects. Ethics provides such a moral reflection. Health technology is a way to improve the life of human individuals. This involves questions of what “the good life” is, and hence ethical issues. Trying to ignore such questions may inflict with the moral foundation of health care: to help people. Additionally, HTA is an evaluation, and as such also a reflection on values. Hence, there is a profound affinity between HTA and ethics. Accordingly, ethics cannot be “integrated” in HTA as ethics is already a constitutive part of HTA. However, ethics can be acknowledged and emphasized.

Keywords

EthicsMethodologyNormativeMoral philosophy
Type
GENERAL ESSAYS
Information
International Journal of Technology Assessment in Health Care , Volume 24 , Issue 4 , October 2008 , pp. 423 - 429
Copyright
Copyright © Cambridge University Press 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1. Andersen, S. MTV og etik, organisation og sundhedsøkonomi. [HTA and ethics, organization and health economy] In: Sigmund, H, Kristensen, FB, eds. MTV, sundhedstjenesteforskning og klinisk praksis. Rapport fra symposium om evidensbaseret sundhedsvæsen. Copenhagen: Statens Institut for Medicinsk Teknologivurdering 2000. http://www.mtv-instituttet.dk.Google Scholar
2. Andersen, S. Etikken. [Ethics]. In: Ingerslev, HJ et al. , eds. Præimplantationsdiagnostik—en medicinsk teknologivurdering. Copenhagen: Medicinsk Teknologivurdering – puljeprojekter; 2002;2:78–100.Google Scholar
3. Ashcroft, RE. Health technology assessment. The concise encyclopedia of the ethics of new technologies. San Diego: Academic Press; 2001:235–244.Google Scholar
4. Autti-Rämö, I, Mäkelä, M. Ethical evaluation in health technology assessment reports: An eclectic approach. Int J Technol Assess Health Care. 2007;23:1–8.CrossRefGoogle ScholarPubMed
5. Banta, HD. Foreword. Poiesis Prax. 2004;2:93–95.CrossRefGoogle Scholar
6. Banta, D. Perry, S. A history of ISTAHC: A personal perspective on its first 10 years. Int J Technol Assess Health Care. 1997;13:430–453.CrossRefGoogle ScholarPubMed
7. Blancquaert, I, Cleret de Langavant, G, Bouchard, L. L'évaluation des technologies de la santé à l'ère de la génomique. Le défi de la complexité. Ruptures, revue transdisciplinaire en santé. 2002;9:22–38.Google Scholar
8. Braunack-Mayer, AJ. Ethics and health technology assessment: Handmaiden and/or critic? Int J Technol Assess Health Care. 2006;22:307–312.CrossRefGoogle ScholarPubMed
9. Caron, L. Integrating ethics into HTA. (Presentation at the HTAi congress in Rome June 20th 2005). http://www.aetmis.gouv.qc.ca/site/276.448.0.0.1.0.phtml.Google Scholar
10. Clausen, C, Yoshinaka, Y. Social shaping of technology in TA and HTA. Poiesis Prax. 2004;2:221–246.CrossRefGoogle Scholar
11. Cleret de Langavant, G. Bioéthique: Méthode et complexité. Québec: Les Presses de l'Université du Québec; 2001.Google Scholar
12. Dreyfus, HL. Heidegger on gaining a free relation to technology. In: Schrader-Frechette, K, Westra, L, eds. Technology and values. New York: Rowman & Littlefield Publishers; 1997:107–114.Google Scholar
13. Droste, S, Gerhardus, A, Kollek, R. Methods for integrating ethical aspects and social values in short HTA-reports. An international inventory. Cologne, Germany: German Agency of Health Technology Assessment at German Institute for Medical Documentation and Information (DAHTA) (DIMDI); 2003:9.Google Scholar
14. EUR-ASSESS Project Subgroup. Report on methodology: Methodological guidance for the conduct of health technology assessment. Int J Technol Assess Health Care. 1997;13:186–219.CrossRefGoogle Scholar
15. Giacomini, M, Miller, F, Browman, G. Confronting the “gray zones” of technology assessment: Evaluating genetic testing services for public insurance coverage in Canada. Int J Technol Assess Health Care. 2003;19:301–316.CrossRefGoogle ScholarPubMed
16. Giacomini, M. One of these things is not like the others: The idea of precedence in health technology assessment and coverage decisions. Milbank Q. 2005;83:193–223.CrossRefGoogle Scholar
17. Grunwald, A. The normative basis of (health) technology assessment and the role of ethical expertise. Poiesis Prax. 2004;2:175–193.CrossRefGoogle Scholar
18. Heitman, E. Ethical issues in technology assessment: Conceptual categories and procedural considerations. Int J Technol Assess Health Care. 1998;14:544–566.CrossRefGoogle ScholarPubMed
19. Hennen, L. Biomedical and bioethical issues in parliamentary TA and in health technology assessment. Poiesis Prax. 2004;2:207–220.CrossRefGoogle Scholar
20. 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
21. Hofmann, B. The technological invention of disease - on disease, technology and values. Thesis. Oslo: University of Oslo, 2002.Google Scholar
22. Hofmann, B. On value-judgements and ethics in health technology assessment. Poiesis Prax. 2005;3:277–295.CrossRefGoogle Scholar
23. Hofmann, B. When means become ends: Technology producing values. Seminar.net - Media, Technology and Lifelong Learning 2006;2. http://www.seminar.net/volume-2-issue-2-2006/when-means-become-ends-technology-produc-ing-values.Google Scholar
24. HTAi and INAHTA. Resources for health technology assessment. http://www.inahta.org/upload/HTA_resources/AboutHTA_Resources_for_HTA.pdf.Google Scholar
25. Ihde, D. Technology and the lifeworld: From garden to earth. Bloomington, Indiana: Indiana University Press; 1990.Google Scholar
26. INAHTA Health Technology Assessment (HTA) Glossary, 2006. http://www.inahta.org/HTA/Glossary/#_H.Google Scholar
27. INAHTA—The International Network of Agencies for Health Technology Assessment. http://www.inahta.org/INAHTA/. Accessed 25 June 2007.Google Scholar
28. Jonsson, E, Banta, HD, Henshall, C, et al. Summary report of the ECHTA/ECAHI project. Int J Technol Assess Health Care. 2002;18:218–237.CrossRefGoogle ScholarPubMed
29. Krones, T, Neuwohner, E, Bock, K et al. , Attitudes of patients, healthcare professionals and ethicists towards embryonic stem cell research and donation of gametes and embryos in Germany. Reproductive Biomedicine Online. www.rbmonline.com/Article/2420. Accessed 29 September 2006.CrossRefGoogle Scholar
30. Krones, T, Schlueter, E, Manolopoulus, K et al. , Public, expert and patient's opinions on preimplantation genetic diagnosis (PGD) in Germany. Reproductive Biomedicine Online. www.rbmonline.com/Article/1547. Accessed 10 November 2004.CrossRefGoogle Scholar
31. Lampe, K, Mäkelä, M. HTA core model for medical and surgical interventions. First public draft, revised 11th of July 2007. http://www.eunethta.net/upload/WP4/EUnetHTA_WP4_CoreModelforInterventions_FirstPublicDraftRevised-2007-07-11.pdf. Accessed 2007.Google Scholar
32. Lehoux, P, Blume, S. Technology assessment and the sociopolitics of health technologies. J Health Polit Policy Law. 2000;25:1083–1120.CrossRefGoogle ScholarPubMed
33. 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
34. Lehoux, P. The problem of health technology. Policy implications for modern health care systems. New York: Routledge; 2006.Google Scholar
35. Lehoux, P, Tailliez, S, Denis, J-L, Hivon, M. Redefining HTA in Canada: Diversification of products and contextualization of findings. Int J Technol Assess Health Care. 2004;20:325–336.CrossRefGoogle ScholarPubMed
36. Maynard, A, McDaid, D. Evaluating health interventions: Exploiting the potential. Health Policy. 2003;63:215–226.CrossRefGoogle ScholarPubMed
37. Molewijk, AC, Stiggelbout, AM, Otten, W, Dupuis, HM, Kievit, J. Implicit normativity in evidence-based medicine: A plea for integrated empirical ethics research. Health Care Anal. 2003;11:69–92.CrossRefGoogle ScholarPubMed
38. Musschenga, AM. Empirical ethics, context -sensitivity, and contextualism. J Med Philos. 2005;30:467–490.CrossRefGoogle ScholarPubMed
39. Office of Technology Assessment (OTA). Development of medical technologies: Opportunities for assessment. Washington, DC: United States Congress; 1976.Google Scholar
40. Reuzel, RP, van der Wilt, GJ, ten Have, HA, de Vries Robbe, PF. Reducing normative bias in health technology assessment: Interactive evaluation and casuistry. Med Health Care Philos. 1999;2:255–263.CrossRefGoogle ScholarPubMed
41. Reuzel, RPB. Interactive technology assessment of paediatric cochlear implantation. Poiesis Prax. 2004;2:119–137.CrossRefGoogle Scholar
42. Reuzel, R, Van der Wilt, GJ. Health technology assessment and evaluation: Back to the basics? Evaluation. 2000;6:383–398.CrossRefGoogle Scholar
43. Rip, A, Misa, TJ, Schot, J, eds. Managing technology in society: The approach of constructive technology assessment. Baltimore; Johns Hopkins University Press; 1995.Google Scholar
44. Saarni, S, Hofmann, B, Lampe, K, Lühmann, D, Mäkelä, M, Velasco-Garrido, M, Autti-Rämö, I. Ethical analysis to improve decision-making on health technologies. Bulletin of the World Health Organization 2008; 86 (8):617–623.CrossRefGoogle ScholarPubMed
45. Skorupinski, B, Ott, K. Technology assessment and ethics. Poiesis Prax. 2002;1:95–122.CrossRefGoogle Scholar
46. ten Have, HA. Medical technology assessment and ethics. Ambivalent relations. Hastings Cent Rep. 1995;25:13–19.CrossRefGoogle ScholarPubMed
47. ten Have, H. Ethical perspectives on health technology assessment. Int J Technol Assess Health Care. 2004;20:71–76.CrossRefGoogle ScholarPubMed
48. Schrader-Frechette, K, Westra, L. Technology and values. New York: Rowman & Littlefield Publishers; 1997.Google Scholar
49. Royal Commission on New Reproductive Technologies. Proceed with care: Final report of the Royal Commission on New Reproductive Technologies. Ottawa: Canada Communications Group-Publishing; 1993.Google Scholar
50. US Congress, Office of Technology Assessment. Strategies for medical technology assessment. Washington, DC: US Government Printing Office; 1982:200–201.Google Scholar
51. Van der Wildt, GJ, Reutzel, R, Banta, HJ. The ethics of assessing health technologies. Theor Med Bioeth. 2000;21:101–113.CrossRefGoogle Scholar
52. Vos, R, Willems, DL. Technology in medicine: Ontology, epistemology, ethics and social philosophy at the crossroads. Theor Med Bioeth. 2000;21:1–7.CrossRefGoogle Scholar