Hostname: page-component-cd9895bd7-gvvz8 Total loading time: 0 Render date: 2024-12-24T05:44:26.180Z Has data issue: false hasContentIssue false
  • English
  • Français

Ethics in Canadian health technology assessment: A descriptive review

Published online by Cambridge University Press:  22 October 2009

Deirdre DeJean ,
Mita Giacomini ,
Lisa Schwartz  and
Fiona A. Miller
Deirdre DeJean
Affiliation:
McMaster University
Mita Giacomini
Affiliation:
McMaster University
Lisa Schwartz
Affiliation:
McMaster University
Fiona A. Miller
Affiliation:
University of Toronto
Get access Rights & Permissions [Opens in a new window]

Abstract

Background: Despite the mandate to examine the medical, ethical, and economic implications of the development and use of health technology, health technology assessment (HTA) reports often emphasize the epidemiologic and economic aspects, and omit ethical considerations. This study examines both whether and how ethical issues are incorporated into HTA.

Objectives: We aim to (i) review a set of Canadian HTA reports for ethics content, (ii) describe the strategies used to incorporate ethically relevant information into HTA, and (iii) determine the presence of implicit ethical issues in a sample of HTA reports.

Methods: Descriptive and qualitative content analysis of 608 HTA reports produced by six Canadian HTA agencies from January 1997 to December 2006.

Results: We found that (i) a minority (17 percent) of Canadian HTA reports addressed ethical issues, (ii) secondary research predominates while primary analysis is rare, (iii) implicit ethical issues are present in HTA reports that do not purport to address ethics.

Conclusions: Canadian HTA reports rarely explicitly, and then only superficially, address ethics, though implicit ethical issues abound.

Keywords

EthicsHealth technology assessmentCanada
Type
General Essays
Information
International Journal of Technology Assessment in Health Care , Volume 25 , Issue 4 , October 2009 , pp. 463 - 469
Copyright
Copyright © Cambridge University Press 2009

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. Ashcroft, R. Health technology assessment. In: The concise encyclopedia of the ethics of new technologies. San Diego: Academic Press; 2001:235–244.Google Scholar
2. Banta, H, Perry, S. A history of ISTAHC. A personal perspective on its first 10 years. International Society of Technology Assessment in Health Care. Int J Technol Assess Health Care. 1997;13:430–453.CrossRefGoogle ScholarPubMed
3. Beauchamp, TL. Principles of biomedical ethics. 5th ed. Oxford: Oxford University Press; 2001.Google Scholar
4. Benatar, D. Bioethics and health and human rights: A critical view. J Med Ethics. 2006;32:17–20.CrossRefGoogle ScholarPubMed
5. Boothroyd, L, Lehoux, P. Home-based chemotherapy for cancer: Issues for patients, caregivers and the health care system. Montreal: Agence d'Evaluation des Technologies et des Modes d'Intervention en Sante (AETMIS); 2004.Google Scholar
6. Brophy, J, Erickson, L. An economic analysis of drug eluting coronary stents: A Quebec perspective. Montreal: Agence d'Evaluation des Technologies et des Modes d'Intervention en Sante (AETMIS); 2004.Google Scholar
7. Brown, A, Coyle, D, Chen, S, Cumming, D, Mensinkai, S. Transdermal hormone replacement therapy patches for women with postmenopausal symptoms: Economic analysis of short-term use. Ottawa: Canadian Coordinating Office for Health Technology Assessment (CCOHTA); 2006.Google Scholar
8. Busse, R, Velasco, M, Perleth, M, et al. Best practice in undertaking and reporting health technology assessments. Working group 4 report. Int J Technol Assess Health Care. 2002;18:361–422.CrossRefGoogle Scholar
9. Callahan, D. Principlism and communitarianism. J Med Ethics. 2003;29:287–291.CrossRefGoogle ScholarPubMed
10. Dahlgren, H. Ethics: Not a mirron parameter for HTA or how could we better integrate ethics into HTA? In: The 6th Symposium on Health Technology Assessment: Cologne; 2005.Google Scholar
11. Davies, C, Wetherell, M, Barnett, E, Seymour-Smith, S. Opening the box: Evaluating the citizens council of NICE. Bristol: The Open University; 2005.Google Scholar
12. Demeter, S, Hailey, D. Non-penetrating glaucoma surgery using AquaFlow(TM) collagen implants. Ottawa: Canadian Coordinating Office for Health Technology Assessment/Office Canadien de Coordination de l'Evaluation des Technologies de la Sante (CCOHTA); 2001.Google ScholarPubMed
13. Draborg, E, Andersen, CK. What influences the choice of assessment methods in health technology assessments? Atatistical analysis of international health technology assessments from 1989 to 2002. Int J Technol Assess Health Care. 2006;22:19–25.CrossRefGoogle ScholarPubMed
14. Draborg, E, Gyrd-Hansen, D. Time-trends in health technology assessments: An analysis of developments in composition of international health technology assessments from 1989 to 2002. Int J Technol Assess Health Care. 2005;21:492–498.CrossRefGoogle ScholarPubMed
15. Framarin, A. First-trimester prenatal screening for Down syndrome and other aneuploidies. Montreal: Agence d'Evaluation des Technologies et des Modes d'Intervention en Sante (AETMIS); 2003.Google Scholar
16. Grunwald, A. The normative basis of (health) technology assessment and the role of ethical expertise. Poeisis Praxis. 2004;2:175–193.CrossRefGoogle Scholar
17. Ho, C, Banerjee, S, Mensinkai, S. Molecular diagnosis for hereditary cancer predisposing syndromes: Genetic testing and clinical impact. Ottawa: Canadian Coordinating Office for Health Technology Assessment (CCOHTA); 2003.Google Scholar
18. 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
19. Hofmann, B. Why ethics should be a part of health technology assessment. I J Technol Assess Health Care. 2008;24:423–429.CrossRefGoogle ScholarPubMed
20. International Network of Agencies for Health Technology Assessment Ethics Working Group. INAHTA's Working Group on Handling Ethical Issues: Final Report; 2005.Google Scholar
21. Jacobs, P, Hailey, D, MacLean, N. Allogeneic stem cell transplantation methods. Edmonton: Alberta Heritage Foundation for Medical Research (AHFMR); 2000.Google Scholar
22. Kahn, T, Ninomiya, H. Changing vocabularies: A guide to help bioethics searchers find relevant literature in National Library of Medicine databases using the Medical Subject Headings (MeSH) indexing vocabulary. Kennedy Inst Ethics J. 2003;13:275–311.CrossRefGoogle ScholarPubMed
23. Lehoux, P. The problem of health technology. New York: Routledge; 2006.Google Scholar
24. Lehoux, P, Law, S. Health care technology at home: Issues in organization and delivery in Quebec. Montreal: Agence d'Evaluation des Technologies et des Modes d'Intervention en Sante (AETMIS); 2004.Google Scholar
25. Lehoux, P, Tailliez, S, Denis, JL, 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
26. 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
27. McGahan, L, Kakuma, R, Ho, C, et al. BRCA1 and BRCA2 predictive genetic testing for breast and ovarian cancers: A systematic review of clinical evidence. Ottawa: Canadian Agency for Drugs and Technologies in Health (CADTH); 2006.Google Scholar
28. Menon, D, Topfer, LA. Health technology assessment in Canada. A decade in review. Int J Technol Assess Health Care. 2000;16:896–902.CrossRefGoogle Scholar
29. Noorani, HZ, McGahan, L. Criteria for selection of adult recipients for heart, cadaveric kidney and liver transplantation. Ottawa: Canadian Coordinating Office for Health Technology Assessment/Office Canadien de Coordination de l'Evaluation des Technologies de la Sante (CCOHTA); 1999.Google Scholar
30. Palylyk-Colwell, E. CYP450 genotyping for determining drug metabolizer status. Ottawa: Canadian Coordinating Office for Health Technology Assessment (CCOHTA); 2006.Google ScholarPubMed
31. Pineau, G, Moqadem, K, St-Hilaire, C, et al. Telehealth: Clinical guidelines and technological standards for telerehabilitation. Montreal: Agence d'Evaluation des Technologies et des Modes d'Intervention en Sante (AETMIS); 2006.Google Scholar
32. Pineau, G, Moqadem, K, St-Hilaire, C. Telehealth: Clinical guidelines and technological standards for telepsychiatry. Montreal: Agence d'Evaluation des Technologies et des Modes d'Intervention en Sante (AETMIS); 2006.Google Scholar
33. Sandelowski, M. Whatever happened to qualitative description? Res Nursing Health. 2000;23:334–340.3.0.CO;2-G>CrossRefGoogle ScholarPubMed
34. Scott, A, Alberta Heritage Foundation for Medical R. Living donor liver transplantation in children. Edmonton: Alberta Heritage Foundation for Medical Research (AHFMR); 2004.Google Scholar
35. Tran, K, Banerjee, S, Li, H, Noorani, H, Mensinkai, S, Dooley, K. Newborn screening for medium chain acyl~CoA cehydrogenase deficiency using tandem mass spectrometry: Clinical and cost-effectiveness Ottawa: Canadian Coordinating Office for Health Technology Assessment (CCOHTA); 2006.Google ScholarPubMed
36. Yunkap Kwankam, MM, Hailey, D, Jacobs, P. Cord blood transplantation. HTA 13. Edmonton, AB: Alberta Heritage Foundation for Medical Research (AHFMR); 1998.Google Scholar