|INAHTA’S WORKING GROUP ON HANDLING ETHICAL ISSUES
INAHTA Ethics Working Group, June 2005
|Ethical analysis in HTA of complex health
Lysdahl et al. Ethical analysis in HTA of complex health interventions. BMC Medical Ethics (2016) 17:16 DOI 10.1186/s12910-016-0099-z
Background: In the field of health technology assessment (HTA), there are several approaches that can be used for ethical analysis. However, there is a scarcity of literature that critically evaluates and compares the strength and weaknesses of these approaches when they are applied in practice. In this paper, we analyse the applicability of some selected approaches for addressing ethical issues in HTA in the field of complex health interventions. Complex health interventions have been the focus of methodological attention in HTA. However, the potential methodological
challenges for ethical analysis are as yet unknown.
Methods: Six of the most frequently described and applied ethical approaches in HTA were critically assessed against a set of five characteristics of complex health interventions: multiple and changing perspectives, indeterminate
phenomena, uncertain causality, unpredictable outcomes, and ethical complexity. The assessments are based on literature and the authors’experiences of developing, applying and assessing the approaches.
Results: The Interactive, participatory HTA approach is by its nature and flexibility, applicable across most complexity characteristics. Wide Reflective Equilibrium is also flexible and its openness to different perspectives makes it better suited for complex health interventions than more rigid conventional approaches, such as Principlism and Casuistry. Approaches developed for HTA purposes are fairly applicable for complex health interventions, which one could expect because they include various ethical perspectives, such as the HTA Core Model® and the Socratic approach.
Conclusion: This study shows how the applicability for addressing ethical issues in HTA of complex health interventions differs between the selected ethical approaches. Knowledge about these differences may be helpful when choosing and applying an approach for ethical analyses in HTA. We believe that the study contributes to increasing awareness and interest of the ethical aspects of complex health interventions in general.
Keywords: Health technology assessment, bioethics, complex health intervention
|Equity and ethical considerations in health technology assessment.
Rama V. Baru. Equity and ethical considerations in health technology assessment. Baru Centre of Social Medicine and Community Health, Jawaharlal Nehru University, New Delhi.