Eliciting Value-Judgments in Health Technology Assessment: An Applied Ethics Decision Making Paradigm

Volume : (11), Issue : (9), May - 2020

Abstract : The worldwide COVID-19 pandemic has shed more light on the difficulty of making health care decisions integrating scientific knowledge and values associated to life and death issues, human suffering, quality of life, economic losses, liberty of movement, etc. But the difficulties related to health care decisions and the use of innovative drugs or technologies are not new, and many countries have created agencies that have the mandate to evaluate new technologies in health care. Health Technological Assessment (HTA) reports’ aim is to guide the decision makers in these difficult matters. There are two ethical components in HTA. The first is the report’s presentation of an ethical evaluation of the technology. The second is the value-ladenness of the HTA decision-making process itself. When implicit value judgments are not elicited, the justification of the final decision cannot be transparent. The present paper aims to identify and elicit the implicit value-judgments related to each step of the HTA process. This research is grounded on a<span "="">n<span "=""> applied ethics decision-making paradigm based on the role of value judgments in the decision-making process. The first part discusses two different approaches to values and value judgments in HTA. In the second part, citations mentioning value judgments extracted from a systematic review on the integration of ethics into HTA were categorized to elicit the value judgments and their criteria for each different HTA decision-making steps. The results show that there are 18 decision-making steps in the HTA process where 23 implicit value-judgments can be recognized. The range of these value judgments encompass<span "="">es<span "=""> the whole HTA process: from the initial request, the presenting of the principal issues, to the final report’s dissemination. Since stakeholders need to understand which value judgments the conclusion of a report relies on, eliciting the implicit value judgments in the HTA decision-making process should yield more transparency.

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Bellemare, C. A., Dagenais, P., Bédard, S. K., Béland, J. P., Bernier, L., Daniel, C. é., Gagnon, H., Legault, G. A., Parent, M., & Patenaude, J. (2018). Ethics in Health Technology Assessment: A Systematic Review. International Journal of Technology Assessment in Health Care, 34, 447-457. https://doi.org/10.1017/S0266462318000508

Bellemare, C. A., Fisette, J., Poder, T. J., Bédard, S., & Dagenais, P. (2017). The Health Technology Assessment Unit of the Centre Hospitalier universitaire de Sherbrooke (Canada). In L. Sampietro-Colom, & J. Martin (Eds.), Hospital-Based Health Technology Assessment: The Next Frontier for Health Technology Assessment (pp. 185-200). Berlin: Springer International Publishing. https://doi.org/10.1007/978-3-319-39205-9_16

Bernier, L., Legault, G. A., Daniel, C. é., K.-Bédard, S., Béland, J. P., Bellemare, C. A., Dagenais, P., Gagnon, H., Parent, M., & Patenaude, J. (2020). Legal Governance in HTA: Environment, Health and Safety Issues/Ethical, Legal and Social Issues (EHSI/ELSI), the Ongoing Debate. Canadian Journal of Bioethics, 3, 83-92. https://doi.org/10.7202/1070226ar

Burls, A., Caron, L., Cleret de Langavant, G., Dondorp, W., Harstall, C., Pathak-Sen, E., & Hofmann, B. (2011). Tackling Ethical Issues in Health Technology Assessment: A Proposed Framework. International Journal of Technology Assessment in Health Care, 27, 230-237. https://doi.org/10.1017/S0266462311000250

Busse, R., Orvain, J., Velasco, M., Perleth, M., Drummond, M., Grtner, F., Jørgensen, T., Jovell, A., Malone, J., Rüther, A., & Wild, C. (2002). Best Practice in Undertaking and Reporting Health Technology Assessments: Working Group 4 Report. International Journal of Technology Assessment in Health Care, 18, 361-422. https://doi.org/10.1017/S0266462302000284

DeJean, D., Giacomini, M., Schwartz, L., & Miller, F. A. (2009). Ethics in Canadian Health Technology Assessment: A Descriptive Review. International Journal of Technology Assessment in Health Care, 25, 463-469. https://doi.org/10.1017/S0266462309990390

Duthie, K., & Bond, K. (2011). Improving Ethics Analysis in Health Technology Assessment. International Journal of Technology Assessment in Health Care. , https://doi.org/10.1017/S0266462310001303

éditeur officiel du Québec (2018). Loi sur l’Institut national d’excellence en santé et en services sociaux. Québec.

European Network for Health Technology Assessment (EUnetHTA) (2016). Joint Action 2, Work Package 8: HTA Core Model, v. 3.

Fletcher, J. F. (1966). Situation Ethics: The New Morality. Philadelphia, PA: Westminster Press.

Hofmann, B. (2013). Health Technology Assessment—Science or Art? GMS Health Technology Assessment, 9, 1-8.

Hofmann, B. M. (2008). Why Ethics Should Be Part of Health Technology Assessment. International Journal of Technology Assessment in Health Care, 24, 423-429. https://doi.org/10.1017/S0266462308080550

Hofmann, B. M., Bond, K., & Sandman, L. (2018). Evaluation Facts and Facting Evaluation: On the Fact-Value Relationship in HTA. Journal of Evaluation in Clinical Practice, 24, 957-965. https://doi.org/10.1111/jep.12920

Hofmann, B., Cleemput, I., Bond, K., Krones, T., Droste, S., Sacchini, D., & Oortwijn, W. (2014a). Revealing and Acknowledging Value Judgments in Health Technology Assessment. International Journal of Technology Assessment in Health Care, 30, 579-586. https://doi.org/10.1017/S0266462314000671

Hofmann, B., Droste, S., Oortwijn, W., Cleemput, I., & Sacchini, D. (2014b). Harmonization of Ethics in Health Technology Assessment: A Revision of the Socratic Approach. International Journal of Technology Assessment in Health Care, 30, 3-9. https://doi.org/10.1017/S0266462313000688

Hofmann, B., Oortwijn, W., Bakke Lysdahl, K., Refolo, P., Sacchini, D., van der Wilt, G. J., & Gerhardus, A. (2015). Integrating Ethics in Health Technology Assessment: Many Ways to Rome. International Journal of Technology Assessment in Health Care, 31, 131-137. https://doi.org/10.1017/S0266462315000276

INAHTA (2005). INAHTA’s Working Group on Handling Ethical Issues. Final Report.

Kristensen, F., & Sigmund, H. (2007). Health Technology Assessment Handbook. Copenhagen: Danish Centre for Health Technology Assessment, National Board of Health.

Legault, G. A. (1999). Professionnalisme et délibération éthique. Presses de l’université du Québec, Sainte Foy, QC, Canada. https://doi.org/10.2307/j.ctv5j01t2

Legault, G. A., Béland, J. P., Parent, M., K.-Bédard, S., Bellemare, C. A., Bernier, L., Dagenais, P., Daniel, C. é., Gagnon, H., & Patenaude, J. (2019). Ethical Evaluation in Health Technology Assessment: A Challenge for Applied Philosophy. Open Journal of Philosophy, 9, 331-351. https://doi.org/10.4236/ojpp.2019.93022

Legault, G. A., Verchères, C., & Patenaude, J. (2018). Support for the Development of Technological Innovations: Promoting Responsible Social Uses. Science and Engineering Ethics, 24, 529-549. https://doi.org/10.1007/s11948-017-9911-5

Legault, G.-A., K.-Bédard, S., Bellemare, C. A., Béland, J.-P., Bernier, L., Dagenais, P., Daniel, C.-é., Gagnon, H., Parent, M., & Patenaude, J. (2018). Revisiting the Fact/Value Dichotomy: A Speech Act Approach to Improve the Integration of Ethics in Health Technology. Open Journal of Philosophy, 8, 578-593. https://doi.org/10.4236/ojpp.2018.85042

Martin, C., Williams-Jones, B., & de Ortúzar, M. G. (2011). Ethical Health Technology Assessment in Latin America: Lessons from Canada and Argentina. Acta Bioethica, 17, 225-236. https://doi.org/10.4067/S1726-569X2011000200009

Patenaude, J., Legault, G.-A., Bernier, L., Beauvais, J., Béland, J.-P., Boissy, P., Chenel, V., Daniel, C.-é., Genest, J., Poirier, M.-S., & Tapin, D. (2015). Framework for the Analysis of Nanotechnologies’ Impacts and Ethical Acceptability: Basis of an Interdisciplinary Approach to Assessing Novel Technologies. Science and Engineering Ethics, 21, 293-315. https://doi.org/10.1007/s11948-014-9543-y

Perelman, C. (1979). The New Rhetoric and the Humanities. Synthese Library (Studies in Epistemology, Logic, Methodology, and Philosophy of Science) Vol. 140, Dordrecht: Springer.

Rawlins, M. D. (2014). Evidence, Values, and Decision-Making. International Journal of Technology Assessment in Health Care, 30, 233-238. https://doi.org/10.1017/S0266462314000154

Reuzel, R., Oortwijn, W., Decker, M., Clausen, C., Gallo, P., Grin, J., Grunwald, A., Hennen, L., van der Wilt, G. J., & Yoshinaka, Y. (2004). Ethics and HTA: Some Lessons and Challenges for the Future. Poiesis & Praxis, 2, 247-256. https://doi.org/10.1007/s10202-003-0054-1

Saarni, S. I., Braunack-Mayer, A., Hofmann, B., & van der Wilt, G. J. (2011). Different Methods for Ethical Analysis in Health Technology Assessment: An Empirical Study. International Journal of Technology Assessment in Health Care, 27, 305-312. https://doi.org/10.1017/S0266462311000444

Saarni, S. I., Hofmann, B., Lampe, K., Luhmann, D., Makela, M., Velasco-Garrido, M., & Autti-Ramo, I. (2008). Ethical Analysis to Improve Decision-Making on Health Technologies. Bulletin of the World Health Organization, 86, 617-623. https://doi.org/10.2471/BLT.08.051078

Sandman, L., & Heintz, E. (2014). Assessment vs. Appraisal of Ethical Aspects of Health Technology Assessment: Can the Distinction Be Upheld? GMS Health Technology Assessment, 10, Doc05.

Strech, D., & Tilburt, J. (2008). Value Judgments in the Analysis and Synthesis of Evidence. Journal of Clinical Epidemiology, 61, 521-524. https://doi.org/10.1016/j.jclinepi.2008.01.001

Ten Have, H. (2004). Ethical Perspectives on Health Technology Assessment. International Journal of Technology Assessment in Health Care, 20, 71-76. https://doi.org/10.1017/S0266462304000819

The Agency for Health Technology Assessment and Tariff System (2016). Health Technology Assessment Guidelines. Warsaw.

The National Institute for Health and Care Excellence (NICE) (2008). Social Value Judgments, Principles for the Development of NICE Guidance.

WHO-HTA (2017). WHO: Medical Devices. WWW Document. http://www.who.int/medical_devices/assessment/en