Ethical Evaluation in Health Technology Assessment: A Challenge for Applied Philosophy
Georges-Auguste Legault,Jean-Pierre Béland,Monelle Parent,Suzanne K. Bédard,Christian Bellemare,Louise Bernier,Pierre Dagenais,Charles-Étienne Daniel,Hubert Gagnon,Johane Patenaude +9 more
TLDR
A systematic review of HTA literature pertaining to the barriers to the integration of ethics in HTA identified nine ethical approaches and shows that the difference between these approaches rests primarily on their disciplinary foundation,rooted in philosophy, philosophy/theology, or sociology.Abstract:
The
integration of ethical analysis in Health Technology Assessment (HTA) has
proven difficult to implement even though it is explicitly recognized as an
important component of such assessments in HTA literature. When compared to the
standardized scientific method for systematic reviews in HTA, the diversity of ethical
analysis has been characterized as a fundamental barrier to the integration of
ethics. The present paper aims to identify the theoretical and practical
differences between the approaches underpinning ethical analysis in HTA and
clarify the reasons for such diversity. Our systematic review of HTA literature
pertaining to the barriers to the integration of ethics in HTA identified nine
ethical approaches: Principlism, Casuistry, Coherence Analysis, Wide Reflective
Equilibrium, Axiology, the Socratic approach, the Triangular model,
Constructive Technology Assessment and Social Shaping of Technology. Citations
pertaining to each approach were extracted and categorized according to three
constitutive components of ethical argumentation established in a previous
research evaluating nanotechnologies: i) the disciplinary foundation that
grounds the validity of the ethical evaluation, ii) the characteristics of such
evaluation, iii) the operational process involved in applying it to a
particular case (i.e., its practical reasoning). This comparison shows that, 1) the
difference between these approaches rests primarily on their disciplinary
foundation (rooted in philosophy, philosophy/theology, or sociology), 2) their
complexity can be observed in the distinct characteristics of ethical
evaluation deriving from their differing disciplinary foundation, and 3)
although four different types of operationalization procedure were identified,
little information was available in regards to the practical reasoning associated
with these approaches.read more
Citations
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Journal ArticleDOI
Advanced therapy medicinal products: value judgement and ethical evaluation in health technology assessment
TL;DR: It has been identified that approaching the specificities of ATMPs in terms of market access will require a broadening of the definition of value to be able to systematically capture elements of value not traditionally considered.
Journal ArticleDOI
Integration of ethical considerations into HTA reports: an analysis of integration levels using a systematic review.
Georges-Auguste Legault,Hubert Gagnon,Monelle Parent,Christian Bellemare,Jean-Pierre Béland,Suzanne Kocsis-Bédard,Louise Bernier,Pierre Dagenais,Charles-Étienne Daniel,Johane Patenaude +9 more
TL;DR: In this paper, a literature search was conducted with the Google™ search engine using the keyword “ethic” between 1 January 2015 and 20 August 2019, yielding 188 reports with a section identified as being on ethics, produced by seventeen HTA agencies in eleven countries.
Journal ArticleDOI
Developing and piloting a context-specified ethics framework for health technology assessment: the South African Values and Ethics for Universal Health Coverage approach
Carleigh B. Krubiner,Nicola Barsdorf,Susan Goldstein,Atiya Mosam,Sunita Potgieter,Michael J. DiStefano,Aviva Tugendhaft,Maria W. Merritt,Ran Li,Kalipso Chalkidou,Ruth R. Faden,Karen Hofman +11 more
TL;DR: The SAVE-UHC approach provides a model for developing, piloting, and refining an ethics framework for health priority-setting that is responsive to national social values and helps identify key facilitators and challenges for integrating ethics analysis into HTA processes.
Journal ArticleDOI
The Value of Explicit, Deliberative, and Context-Specified Ethics Analysis for Health Technology Assessment: Evidence From a Novel Approach Piloted in South Africa.
Carleigh B. Krubiner,Aviva Tugendhaft,Michael J. DiStefano,Nicola Barsdorf,Maria W. Merritt,Susan Goldstein,Atiya Mosam,Sunita Potgieter,Karen Hofman,Ruth R. Faden +9 more
TL;DR: The South African Values and Ethics for Universal Health Coverage (SAVE-UHC) approach, piloted in South Africa, consisted of two phases: (1) convening a national multistakeholder working group to develop a provisional ethics framework and (2) testing the provisional ethical framework through simulated health technology assessment appraisal committee meetings (SACs) as discussed by the authors .