Hostname: page-component-cd9895bd7-gxg78 Total loading time: 0 Render date: 2024-12-22T19:17:28.908Z Has data issue: false hasContentIssue false
  • English
  • Français

Mapping the integration of social and ethical issues in health technology assessment

Published online by Cambridge University Press:  18 January 2007

Pascale Lehoux  and
Bryn Williams-Jones
Pascale Lehoux
Affiliation:
University of Montreal
Bryn Williams-Jones
Affiliation:
University of Montreal
Get access Rights & Permissions [Opens in a new window]

Abstract

Background: Since its inception, the field of health technology assessment (HTA) has stressed the need for consideration of ethical and social issues. However, few concepts or analytic tools have been developed, and because of the complexity of the endeavor and a lack of integration of work already produced, such concepts remain difficult to apply in HTA.

Objectives: Through a descriptive “map” of concepts, tools, and processes, we summarize the most tangible efforts on the part of HTA producers to address social and ethical issues.

Methods: A literature review and content analysis of HTA reports in the Centre for Reviews and Dissemination database enables a synthesis of the reflections on, initiatives around, and gaps in knowledge related to the integration of social and ethical issues in HTA.

Results: We examine: (i) the aim of integrating ethical and social issues in HTA, (ii) the theoretical approaches used, (iii) the methods and processes applied, and (iv) the implications for HTA producers. We highlight two levels at which social and ethical issues can be considered: throughout the production process of HTA reports and as part of the organizational structure of HTA agencies.

Conclusions: Given the profound societal changes that occur in relation to healthcare technology development, HTA producers have a responsibility to inform and enlighten technology-related public and policy debates. Fulfilling this role, though, requires that socioethical dimensions of technology and HTA are made explicit.

Keywords

Health technology assessmentHTAEthicsSocial issuesValuesPolicy making
Type
GENERAL ESSAYS
Information
International Journal of Technology Assessment in Health Care , Volume 23 , Issue 1 , January 2007 , pp. 9 - 16
Copyright
© 2007 Cambridge University Press

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

Abelson J, Forest P-G, Eyles J, et al. 2003 Deliberations about deliberative methods: Issues in the design and evaluation of public participation processes. Soc Sci Med. 57: 239– 251.Google Scholar
Anderson Garcia S. 1996 Sociocultural and legal implications of creating and sustaining life through biomedical technology. J Legal Med. 17: 469– 525.Google Scholar
Banta D. 1997 Perry S. A history of ISTAHC: A personal perspective on its first 10 years. Int J Technol Assess Health Care. 13: 430– 453.Google Scholar
Burgess MM. 2003 Public consultation in ethics: An experiment in representative ethics. J Bioeth Inq. 1: 4– 13.Google Scholar
Cleret de Langavant G. 2000 Method and complexity in bioethics: The example of community genetics. Community Genet. 3: 141– 143.Google Scholar
De Vries R. 2002 How can we help? From “sociology in” to “sociology of” bioethics. J Law Med Ethics. 32: 279– 92.Google Scholar
Dixon-Woods M, Agarwal S, Young B, Jones D, Sutton A. 2004. Integrative approaches to qualitative and quantitative evidence. London: National Health Service (NHS), Health Development Agency;
Droste S, Gerhardus A, Kollek R. 2003: Methods for integrating ethical aspects and social values in short HTA-reports. An international inventory. German Agency of Health Technology Assessment at German Institute for Medical Documentation and Information (DAHTA) (DIMDI); 9.
Gallo P. 2004 Integrating ethical enquiry and health technology assessment: Limits and opportunities for efficiency and equity. Poiesis Praxis. 2: 103– 117.Google Scholar
Giacomini M, Hurley J, Gold I, Smith P, Abelson J. 2004 The policy analysis of “values talk”: Lessons from Canadian health reform. Health Policy. 67: 15– 24.Google Scholar
Giacomini M, Miller F, Browman G. 2003 Confronting the “gray zones” of technology assessment: Evaluating genetic testing services for public insurance coverage in Canada. Int J Technol Assess Health Care. 19: 301– 316.Google Scholar
Grin J. 2004 Health technology assessment between our health care system and our health. Poiesis Praxis. 2: 157– 174.Google Scholar
Grunwald A. 2004 The normative basis of (health) technology assessment and the role of ethical expertise. Poiesis Praxis. 2: 175– 194.Google Scholar
Haimes E. 2002 What can the social sciences contribute to the study of ethics? Theoretical, empirical and substantive considerations. Bioethics. 16: 89– 113.Google Scholar
Hasman A. 2003 Eliciting reasons: Empirical methods in priority setting. Health Care Anal. 11: 41– 58.Google Scholar
Hofmann B. 2005 Toward a procedure for integrating moral issues in health technology assessment. Int J Technol Assess Health Care. 21: 312– 318.Google Scholar
Hoffmaster B. 1992 Can ethnography save the life of medical ethics. Soc Sci Med. 35: 1421– 1431.Google Scholar
Heitman E. 1998 Ethical issues in technology assessment: Conceptual categories and procedural considerations. Int J Technol Assess Health Care. 14: 544– 566.Google Scholar
Heitman E. 1999 Social and ethical aspects of in vitro fertilization. Int J Technol Assess Health Care. 15: 22– 35.Google Scholar
Johri M, Lehoux P. 2003 The great escape? Health technology assessment as a means of cost control. Int J Technol Assess Health Care. 19: 179– 193.Google Scholar
Kenen RG. 1996 The at-risk health status and technology: A diagnostic invitation and the “gift” of knowing. Soc Sci Med. 42: 1545– 1553.Google Scholar
Kmet L, Lee RC, Cook LS, et al. 2004. Alberta Heritage Foundation for Medical research (AHFMR). Systematic review of the social, ethical, and legal dimensions of genetic cancer risk assessment. AHFMR: Edmonton;
Lavis JN, Ross SE, Hurley JE, et al. 2002 Examining the role of health services research in public policy-making. Milbank Q. 80: 125– 154.Google Scholar
Lehoux P. 2006. The problem of health technology. Policy implications for modern health care systems. New York: Routledge;
Lehoux P, Blume S. 2000 Technology assessment and the sociopolitics of health technologies. J Health Polit Policy Law. 25: 1083– 1120.Google Scholar
Lehoux P, Tailliez S, Denis J-L, Hivon M. 2004 Redefining HTA in Canada: Diversification of products and contextualization of findings. Int J Technol Assess Health Care. 20: 325– 336.Google Scholar
Leroux T, Hirtle M, Fortin L-N. 1998 An overview of public consultation mechanisms developed to address the ethical and social issues raised by biotechnology. J Consum Policy. 21: 445.Google Scholar
Moldrup C. 2002 Medical technology assessment of the ethical, social, and legal implications of pharmacogenomics. A research proposal for an Internet citizen jury. Int J Technol Assess Health Care. 18: 728– 732.Google Scholar
Molewijk AC, Stiggelbout AM, Otten W, Dupuis HM, Kievit J. 2004 Implicit normativity in evidence-based medicine: A plea for integrated empirical ethics research. Health Care Anal. 11: 69– 92.Google Scholar
Murphy E, Dingwall R, Greatbatch D, et al. 1998 Qualitative research methods in health technology assessment: A review of the literature. Health Technol Assess. 2: iii– ix, 1-274.Google Scholar
National Institute for Clinical Excellence (NICE). Citizens Council Report on age. NICE: London; Undated.
National Institute for Clinical Excellence (NICE). 2005. Social value judgements. Principles for the development of NICE guidance. NICE: London;
Oortwijn W, Reuzel R, Decker M. 2004 Introduction. Poiesis Praxis. 2: 97– 102.Google Scholar
Reiter-Theil S. 2004 Does empirical research make bioethics more relevant? The “embedded researcher” as a methodological approach. Med Health Care Philos. 7: 17– 29.Google Scholar
Reuzel R, Oortwijn W, Decker M, et al. 2004 Ethics and HTA: Some lessons and challenges for the future. Poiesis Praxis. 2: 247– 256.Google Scholar
Royle J, Oliver S. 2004 Consumer involvement in the health technology assessment program. Int J Technol Assess Health Care. 20: 493– 497.Google Scholar
van der Wilt GJ. 2004 Health technology assessment: Trying to bring empirical and ethical inquiry together. Poiesis Praxis. 2: 195– 206.Google Scholar
ten Have H. 2004 Ethical perspectives on health technology assessment. Int J Technol Assess Health Care. 20: 71– 76.Google Scholar
Webster A. 2004 Health technology assessment: A sociological commentary on reflexive innovation. Int J Technol Assess Health Care. 20: 61– 66.Google Scholar
Williams T, May C, Mair F, Mort M, Gask L. 2003 Normative models of health technology assessment and the social production of evidence about telehealth care. Health Policy. 64: 39– 54.Google Scholar
Williams-Jones B, Burgess MM. 2004 Social contract theory and just decision making: Lessons from genetic testing for BRCA mutations. Kennedy Inst Ethics J. 14: 115– 142.Google Scholar
Williams-Jones B, Graham JE. 2003 Actor-network theory: A tool to support ethical analysis of commercial genetic testing. New Genet Soc. 22: 271– 296.Google Scholar