Why ethics should be part of health technology assessment

2008 ◽  
Vol 24 (04) ◽  
pp. 423-429 ◽  
Author(s):  
Bjørn Morten Hofmann
Keyword(s):  
Health Care ◽  
Technology Assessment ◽  
Good Life ◽  
Ethical Issues ◽  
Health Technology ◽  
Ethical Analysis ◽  
The Good Life ◽  
Moral Foundation ◽  
Ethical Approaches ◽  
Integrating Ethics

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 anevaluation, 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.

OP101 Do We Need To Extend Health Technology Assessment To Health Enhancement Assessment?

2017 ◽  
Vol 33 (S1) ◽  
pp. 46-46
Author(s):  
Bjørn Hofmann
Keyword(s):  
Health Care ◽  
Health Technology Assessment ◽  
Technology Assessment ◽  
Cognitive Abilities ◽  
Literature Search ◽  
Ethical Issues ◽  
Health Technology ◽  
Health Technologies ◽  
Health And Wellbeing ◽  
Wide Range

INTRODUCTION:Several health technologies used for therapy can also be used for health enhancement. Drugs stimulating cognitive abilities are but one example. Health Technology Assessment (HTA) has not been developed for assessing enhancements. This raises the question of how HTA should address the blurred distinction between therapy and enhancement. Should we (i) carve out a distinction between therapy and enhancement and limit HTA to therapy, (ii) use HTA for both therapy and enhancement (with some modifications), or (iii) should we develop a separate health enhancement assessment (HEA)?METHODS:A literature search of the medical, philosophical, and bioethical literature was conducted for debates, arguments, and suggested solutions to the issue of therapy versus enhancement.RESULTS:The same improvement in health may be therapeutic in one patient, but an enhancement in another. Moreover, both therapy and enhancement share the same goal: increased health and wellbeing. A wide range of arguments try to establish a difference between therapy and enhancement. They refer to naturalness, rehabilitation, normality, species-typical functioning/potential, disease, sustainability, and responsibility. On closer scrutiny few of these arguments do the job in bolstering the therapy-enhancement distinction. We already use a wide range of means to extend human abilities. Moreover, the therapy-enhancement distinction raises a wide range of ethical issues that are relevant for the assessment of a number of emerging health technologies.CONCLUSIONS:Existing HTA methodology can address a wide range of non-therapeutic health enhancements. However, a series of broader issues related to the goal of health care and responsibility for altering human evolution may not be addressed within traditional HTA frameworks. Specific HEAs may therefore be helpful.

scholarly journals TO EVALUATE VERSUS TO KNOW THE VALUE OF EVERYTHING

2012 ◽  
Vol 28 (2) ◽  
pp. 196-197
Author(s):  
Bjørn Hofmann ◽  
Samuli I. Saarni ◽  
Annette Braunack-Mayer ◽  
Gert Jan van der Wilt
Keyword(s):  
Health Care ◽  
Empirical Study ◽  
Good Life ◽  
Well Being ◽  
Health Technology ◽  
Ethical Analysis ◽  
Concept Of Disease ◽  
Definition Of ◽  
Over The Top

Kathrin Dengler and Uta Bittner demand a full-fledged philosophy of values in our empirical study of various methods for ethical analysis in health technology assessment (HTA). This may be like putting the classification of disease on hold until the concept of disease is clarified, or postponing the development of health care until the term “health” is clarified. As Dengler and Bittner rightly point out, the term value has many meanings, and as they properly recognize: “[P]hilosophically, the definition of what is meant by ‘a good life’ or ‘well-being’ is a very challenging project.” Hence, it may be a bit over the top to crave that we solve eternal issues in an empirical article on methodology.

scholarly journals WHAT DO WE MEAN BY TALKING ABOUT “VALUE(S)”? A REPLY TO SAARNI ET AL.

2012 ◽  
Vol 28 (2) ◽  
pp. 195-196
Author(s):  
Kathrin Dengler ◽  
Uta Bittner
Keyword(s):  
Health Care ◽  
Empirical Study ◽  
Health Technology Assessment ◽  
Technology Assessment ◽  
Health Technology ◽  
Ethical Analysis ◽  
Ethical Evaluations

In their article “Different methods for ethical analysis in health technology assessment: An empirical study” published inInternational Journal of Technology Assessment in Health Care, Volume 27 Number 4, Samuli I. Saarni, Annette Braunack-Mayer, Bjørn Hofmann, and Gert Jan van der Wilt present an empirical study about different methods for ethical analysis in health technology assessment (HTA). They claim that ethical analysis is an important issue which can highlight values inherent in a technology and value-decisions underlying a HTA process (4). Although their study is rich in detail; gives an interesting overview of casuistry, principlism, and axiological ethic frameworks; and make ethical evaluations within HTA more transparent, we suppose, one important point needs further serious discussion: the clarification of what is meant by “value.”

scholarly journals Different methods for ethical analysis in health technology assessment: An empirical study

2011 ◽  
Vol 27 (4) ◽  
pp. 305-312 ◽  
Author(s):  
Samuli I. Saarni ◽  
Annette Braunack-Mayer ◽  
Bjørn Hofmann ◽  
Gert Jan van der Wilt
Keyword(s):  
Empirical Study ◽  
Health Technology Assessment ◽  
Obesity Surgery ◽  
Technology Assessment ◽  
Ethical Issues ◽  
Personal Responsibility ◽  
Public Funding ◽  
Stakeholder Involvement ◽  
Health Technology ◽  
Ethical Analysis

Objectives: Ethical analysis can highlight important ethical issues related to implementing a technology, values inherent in the technology itself, and value-decisions underlying the health technology assessment (HTA) process. Ethical analysis is a well-acknowledged part of HTA, yet seldom included in practice. One reason for this is lack of knowledge about the properties and differences between the methods available. This study compares different methods for ethical analysis within HTA.Methods: Ethical issues related to bariatric (obesity) surgery were independently evaluated using axiological, casuist, principlist, and EUnetHTA models for ethical analysis within HTA. The methods and results are presented and compared.Results: Despite varying theoretical underpinnings and practical approaches, the four methods identified similar themes: personal responsibility, self-infliction, discrimination, justice, public funding, and stakeholder involvement. The axiological and EUnetHTA models identified a wider range of arguments, whereas casuistry and principlism concentrated more on analyzing a narrower set of arguments deemed more important.Conclusions: Different methods can be successfully used for conducting ethical analysis within HTA. Although our study does not show that different methods in ethics always produce similar results, it supports the view that different methods of ethics can yield relevantly similar results. This suggests that the key conclusions of ethical analyses within HTA can be transferable between methods and countries. The systematic and transparent use of some method of ethics appears more important than the choice of the exact method.

Health technology assessment of utilization, practice and ethical issues of self-pay services in the German ambulatory health care setting

2013 ◽  
Vol 59 (1) ◽  
pp. 175-187 ◽  
Author(s):  
Theresa Hunger ◽  
Petra Schnell-Inderst ◽  
Katharina Hintringer ◽  
Ruth Schwarzer ◽  
Vanadin Seifert-Klauss ◽  
...  
Keyword(s):  
Health Care ◽  
Health Technology Assessment ◽  
Technology Assessment ◽  
Care Setting ◽  
Ethical Issues ◽  
Health Technology ◽  
Health Care Setting ◽  
Ambulatory Health Care

scholarly journals HOW TO INTRODUCE MORE (OR BETTER) ETHICAL ARGUMENTS IN HTA?

2015 ◽  
Vol 31 (3) ◽  
pp. 111-112 ◽  
Author(s):  
Erik Schokkaert
Keyword(s):  
Decision Making ◽  
Technology Assessment ◽  
Good Life ◽  
Health Technology ◽  
The Good Life ◽  
Ethical Values ◽  
Health Technologies ◽  
Life Evaluation ◽  
Conception Of The Good

All evaluation exercises involve ethical values, as they require some conception of the “good life.” Evaluation of health technologies is no exception. Because there is no consensus about what is a good life, we have to devise decision-making procedures in which citizens with different opinions are heard and treated fairly (1). The purpose of health technology assessment (HTA) is to offer useful input into this process so as to increase the quality of the deliberations and of the resulting decisions. How to bring ethical values into this process?

Core competencies for ethics experts in health technology assessment

2020 ◽  
Vol 36 (6) ◽  
pp. 534-539
Author(s):  
Pietro Refolo ◽  
Kenneth Bond ◽  
Bart Bloemen ◽  
Ilona Autti-Rämö ◽  
Bjørn Hofmann ◽  
...  
Keyword(s):  
Health Technology Assessment ◽  
Technology Assessment ◽  
Ethical Issues ◽  
Core Competencies ◽  
Health Technology ◽  
Ethical Analysis ◽  
Specific Knowledge ◽  
Face To Face ◽  
Ethical Expertise ◽  
Ethics Expertise

AbstractObjectivesThere is no consensus on who might be qualified to conduct ethical analysis in the field of health technology assessment (HTA). Is there a specific expertise or skill set for doing this work? The aim of this article is to (i) clarify the concept of ethics expertise and, based on this, (ii) describe and specify the characteristics of ethics expertise in HTA.MethodsBased on the current literature and experiences in conducting ethical analysis in HTA, a group of members of the Health Technology Assessment International (HTAi) Interest Group on Ethical Issues in HTA critically analyzed the collected information during two face-to-face workshops. On the basis of the analysis, working definitions of “ethics expertise” and “core competencies” of ethics experts in HTA were developed. This paper reports the output of the workshop and subsequent revisions and discussions online among the authors.ResultsExpertise in a domain consists of both explicit and tacit knowledge and is acquired by formal training and social learning. There is a ubiquitous ethical expertise shared by most people in society; nevertheless, some people acquire specialist ethical expertise. To become an ethics expert in the field of HTA, one needs to acquire general knowledge about ethical issues as well as specific knowledge of the ethical domain in HTA. The core competencies of ethics experts in HTA consist of three fundamental elements: knowledge, skills, and attitudes.ConclusionsThe competencies described here can be used by HTA agencies and others involved in HTA to call attention to and strengthen ethical analysis in HTA.

HEALTH TECHNOLOGY ASSESSMENT IN THE NETHERLANDS

2000 ◽  
Vol 16 (2) ◽  
pp. 485-519 ◽  
Author(s):  
Michael Bos
Keyword(s):  
Health Care ◽  
Health Technology Assessment ◽  
Technology Assessment ◽  
Private Insurance ◽  
National Level ◽  
Health Technology ◽  
Care Quality ◽  
High Tech ◽  
Fee For Service ◽  
Equal Distribution

The Dutch healthcare system is not a single overall plan, but has evolved from a constantly changing mix of institutions, regulations, and responsibilities. The resulting system provides high-quality care with reasonable efficiency and equal distribution over the population. Every Dutch citizen is entitled to health care. Health insurance is provided by a mix of compulsory national insurance and public and private insurance schemes. Hospitals generally have a private legal basis but are heavily regulated. Supraregional planning of high-tech medical services is also regulated. Hospitals function under fixed, prospective budgets with regulation of capital investments. Independent general practitioners serve a gatekeeper role for specialist and hospital services and are paid by capitation or fee for service. Specialists are paid by fee for service. All physicians' fees are controlled by the Ministry of Economic Affairs. Coverage of benefits is an important method of controlling the cost of services. There is increasing concern about health care quality. Health technology assessment (HTA) has become increasingly visible during the last 15 years. A special national fund for HTA, set up in 1988, has led to many formal and informal changes. HTA has evolved from a research activity into policy research for improving health care on the national level. In 1993 the government stated formally that enhancing effectiveness in health care was one of its prime targets and that HTA would be a prime tool for this purpose. The most important current issue is coordination of HTA activities, which is now undertaken by a new platform representing the important actors in health care and HTA.

Europe: Barbara Stocking King's Fund Centre for Health Services Development

1988 ◽  
Vol 4 (1) ◽  
pp. 143-152
Author(s):  
Bernard S. Bloom ◽  
H. David Banta ◽  
Paul F. Gross ◽  
Jorge Peña-Mohr ◽  
Jane E. Sisk ◽  
...  
Keyword(s):  
Health Care ◽  
Quality Assurance ◽  
International Society ◽  
Technology Assessment ◽  
Health Technology ◽  
Modern Technology ◽  
National Society ◽  
Health Care Managers ◽  
Society Meeting ◽  
Care Managers

May and June were busy months in Europe for technology assessors. Following the International Society meeting in Rotterdam, many people went on to the quality assurance meeting at WHO in Copenhagen and the International Hospital Federation Congress in Helsinki. “Modern Technology—How Much and for Whom,” was one of the main themes of the congress; with an attendance of about 400 there was an opportunity to get the ideas about technology assessment across to a large group of health care managers and professionals. For those of us who spoke it was also a chance to meet members of the Finnish Society for Technology Assessment. This may be the only national society for health technology assessment, and with 70 members, it is clearly going to be influential.

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