The Role of Ethics in Health Technology Assessment

The formal process of HTA involves the safe, economical, and efficient assessment of medical technology. It is becoming more and more integrated into the current healthcare system. However, after the evaluation of these obvious parameters, there comes an important dimension that is a requirement but is usually problematic because of the addition of further complications. The dimension is ethics. Thus, ethics in HTA would involve checking all the dimensions of the new health technologies for their moral implications, which are usually deep for society. It is with the changing and developing nature of healthcare technologies that the need for reflecting on the ethical dimensions of HTA has become more pressing. It ensures proper netting of technological development in view of the values of society with respect to individual rights, not increasing health inequalities, by careful conscientious consideration. Thus, the present essay shall strive to discuss the various roles, its importance, and the associated challenges, as well as the approaches and possible future directions for ethics in HTA.

Understanding the Ethical Dimensions

Some of the ethical dimensions of HTA may stretch beyond clinical and economic dimensions to include evaluation of the moral and societal implications of health technologies. Indeed, these very dimensions are important, as the technologies could impact the people either positively or negatively. Ethical considerations could be based on factors such as patient autonomy, justice, equity, and possible consequences for society in the long run.

Justice and equity are among the major ethical concerns in HTA. Health technologies need assessment for their capacities to either magnify or abate health disparities. For example, with certain advanced medical devices, which are affordable only for the rich, this may result in a pitfall in health inequalities. Assessment of equitable distribution of health technologies will ensure benefits for all sections of society, in particular the most vulnerable and weak sections.

Another critical ethics dimension is patient autonomy. As technologies are getting more complicated, it might be challenging for patients to understand the technology; thus, the foundation of ethics-based HTA is the need for informed consent and patient engagement regarding the decision of treatment. It puts forth that patients are offered clear and integrated information on both the benefits and possible risks of the technology and alternates so that a selection regarding health can be made.

The Integration of Ethics in HTA Methodologies

Integration of ethics in methods of HTA is a very thorny but inevitable area. Hence, quite a few methods have been developed to consciously introduce ethical considerations into HTA in a structured manner. Such approaches more frequently have involved the incorporation of standards or guidelines that provide evaluators with tools for the assessment of the ethical implications of health technologies.

One of the well-recognized methods is to include the membership of ethical experts on HTA panels, which provides an addition of a unique appraisal outlook for the appraisal process in regards to ethical dimensions. They can provide insights into the potential societal impacts of a technology, identify ethical dilemmas, and suggest ways to address them.

Some HTA agencies have gone beyond and developed their own methodological guidance documents, giving advice on how to go about evaluating ethical considerations in their work. Such guidance frequently includes checklists or criteria against which various ethical dimensions could be assessed both within and between considerations of equity, patient autonomy, or societal impact. Such systematic guidance ensures that ethical reflection is provided throughout the HTA process.

Another strategy on how to infuse ethics into HTA is the infusion of deliberative processes. The inclusion of stakeholders would encompass patients, providers, the public, or any other party that may have an interest in or be affected by a technology to discuss its ethical ramifications. Open deliberative processes serve to unearth ethical issues that would be very hard to point out on a more conventional assessment. This participatory approach guarantees that divergent views are taken on board, thereby advocating for more holistic and ethically sensitive inquiries.

Yearwise Publication Trend on health technology assessment

Find publication trends on relevant topics

The Challenges of Integrating Ethics in HTA

There are especially many problems in the relationship between HTA and ethics. The most prominent handicap is that ethics cannot be given an objective basis. Unlike clinical and economic evaluations, ethical appraisals are grounded not by objective data but by more or less subjective judgments that are property dependent upon cultural, societal, or individual conventions. This undermines the possibility of developing methodologies for defining and appraising the ethical aspects in a coherent way, thereby being eroded into inconsistencies in parallel evaluations.

As a result, one of the challenges is the likely clash between ethical and economic criteria. In some cases, this might mean that a technology is economically feasible, yet it poses serious ethical concerns. For example, an approach that is cheap in treating a condition may also compromise efficiency, equity, or patient autonomy in a manner that is morally problematic. The balancing of economic efficiency with ethical considerations needs to be done carefully and, at times, may require uncomplicated trade-offs.

Either way, the speed of technological change is extremely rapid, so the ethical evaluation is very challenging for evaluators. When a new technology is integrated into a healthcare system, ethical considerations do not keep pace with technological advancements. Far-off implications will be difficult for evaluators to project when encountering and debating emerging technologies that are quite unprecedented in form or effect on society.

Stakeholder Involvement: Why it is Important

Stakeholder involvement is an important component of ethical HTA. The engagement of diverse stakeholders patients, professionals, policymakers in health, and the general public may yield important information on the ethical dimensions of health technologies. Diverse stakeholders participate in the identification of multifaceted issues related to health technologies.

Lastly, involving stakeholders during the HTA process increases transparency and accountability. By opening up communication channels with its stakeholders, HTA agencies are provided with the room to act as avenues for an open and transparent evaluation process, which can help to instill trust and confidence. The involvement of stakeholders also helps in holding the evaluators responsible for making an effort toward including the ethical considerations in the reviewing process so that the importance of those considered variables cannot be simply sidestepped for the stronger quantifiable measures.

Also, stakeholder involvement is a key factor in increasing the social acceptability of health technologies. Public involvement can be attained by making the views of people be part of the process of assessment so that the findings of the health technologies satisfy the values and preferences of society. This can hasten technologies embracing and also adapting some critical technologies that advance ethical problems.

Ethical Frameworks in HTA

Several ethical frameworks have been proposed in which HTA evaluators can consider the moral implications of health technologies. Such frameworks can provide a structure for the approach to identifying and managing ethical issues and are also a step to ensure systematic and transparent evaluations.

Among the widely used frameworks, the four-principles approach is one that anchors ethical deliberation around four key ethical principles: autonomy, beneficence, nonmaleficence, and justice. This approach highlights respect for patient autonomy, good practice in the promotion of well-being, non-harm, and fair distribution of benefits and burdens. These principles are used to provide a systematic way of measuring the various ethical dimensions of health technologies and ensuring that these considerations are integrated within the evaluation.

Another common ethical framework applied within HTA is the public health ethics framework, which acknowledges the necessity of evaluating health technologies against a background of public health goals and values. Among the key issues addressed in the framework are questions of equity, justice, societal implications of health technologies, and making sure evaluations are aligned with public health priorities.

Moreover, with regard to the capability approach, the entry of ethics into HTA has been expended on the evaluation of the effects of health technologies on the array of people’s capabilities and opportunities but not gotten entangled with their health outcomes. By focusing on what health technologies enable people to do, this approach captures the overall societal and individual implications of the technologies and therefore captures feature evaluations that further the cause of human well-being and dignity.

Recent Publications on health technology assessment

Find publications on relevant topics

The Future of Ethics in HTA

The more technologies in healthcare are developed and upgraded, the more an important place ethics is likely to take in HTA. Indeed, the new technologies, in particular artificial intelligence, genetic engineering, and the use of personalized medicine, raise a row of new ethical problems that simply need adequate consideration. Those same technologies could radically change healthcare but also give rise to very complex questions of ethics regarding privacy, consent, and equality.

All these difficulties argue for more flexibility in further development of ethical assessment in future activities of HTA agencies. This could be achieved by methodological development for appraisal of emerging technologies, greater involvement of stakeholders, and international cooperation in order to establish a common frame for ethical standards beyond borders.

In addition, there may be a need for further development of ethics education in relation to the HTA practice. Only when evaluators possess adequate education in the principles of ethical assessment could HTA agencies ensure correct representation of these issues in the assessment process. Education in ethics may involve, but not be limited to, techniques for including ethics in HTA education programs, an improvement in interdisciplinary collaboration, and the promotion of ethical sensitivity.

Issues of ethics will consequently extend to, in the future, not only individual technologies but include the field in the healthcare systems and policies. In the pressure of making the systems of healthcare attain a cost-quality-access balance, the ethical evaluation would play very pivotal roles in advising policies and decisions in an effective and fair apportioning of healthcare resources.

Conclusion

Ethics is multifaciously important to health technology assessment; it assures a prudent and conscientious appraisal of health technologies. In accommodative ways, HTA can cover the essential ethical considerations to make sure that technological development adheres to societal values, being respectful of the rights of entities, and being responsible for the foundation and maintenance of a fair and just healthcare system. Some issues, however, are usually related when ethics are integrated in HTA, such as the variable subjective nature of ethical evaluation, conflicts with economic considerations, and fast technological developments. Therefore, HTA agencies need to manage the issues of subjectivity in ethical evaluation by involving stakeholders, structuring ethical frameworks, changing elaboration processes, and changing evaluation processes because of changes in technology. With the evolution of healthcare services, the significance of ethics in HTA will continue to guide responsible and equitable healthcare decision-making.

References

  1. Hofmann B, Oortwijn W, Bakke Lysdahl K, Refolo P, Sacchini D, van der Wilt GJ, Gerhardus A. Integrating ethics in health technology assessment: many ways to Rome. Int J Technol Assess Health Care. 2015 Jan;31(3):131-7. doi: 10.1017/S0266462315000276. Epub 2015 Jun 11. PMID: 26063128.
  2. Assasi N, Schwartz L, Tarride JE, Campbell K, Goeree R. Methodological guidance documents for evaluation of ethical considerations in health technology assessment: a systematic review. Expert Rev Pharmacoecon Outcomes Res. 2014 Apr;14(2):203-20. doi: 10.1586/14737167.2014.894464. PMID: 24625039.
  3. Abelson J, Wagner F, DeJean D, Boesveld S, Gauvin FP, Bean S, Axler R, Petersen S, Baidoobonso S, Pron G, Giacomini M, Lavis J. PUBLIC AND PATIENT INVOLVEMENT IN HEALTH TECHNOLOGY ASSESSMENT: A FRAMEWORK FOR ACTION. Int J Technol Assess Health Care. 2016 Jan;32(4):256-264. doi: 10.1017/S0266462316000362. Epub 2016 Sep 27. PMID: 27670693.
  4. Chamova, J. and Lange, J., 2013. European network for health technology assessment–EUnetHTAMedical Writing22(3), pp.190-191.
  5. Drummond MF, Schwartz JS, Jönsson B, Luce BR, Neumann PJ, Siebert U, Sullivan SD. Key principles for the improved conduct of health technology assessments for resource allocation decisions. Int J Technol Assess Health Care. 2008 Summer;24(3):244-58; discussion 362-8. doi: 10.1017/S0266462308080343. PMID: 18601792.
  6. Oortwijn W, Jansen M, Baltussen R. Use of Evidence-Informed Deliberative Processes by Health Technology Assessment Agencies Around the Globe. Int J Health Policy Manag. 2020 Jan 1;9(1):27-33. doi: 10.15171/ijhpm.2019.72. PMID: 31902192; PMCID: PMC6943303.
  7. Draborg E, Gyrd-Hansen D, Poulsen PB, Horder M. International comparison of the definition and the practical application of health technology assessment. Int J Technol Assess Health Care. 2005 Winter;21(1):89-95. doi: 10.1017/s0266462305050117. PMID: 15736519.
  8. Noorani HZ, Husereau DR, Boudreau R, Skidmore B. Priority setting for health technology assessments: a systematic review of current practical approaches. Int J Technol Assess Health Care. 2007 Summer;23(3):310-5. doi: 10.1017/s026646230707050x. Erratum in: Int J Technol Assess Health Care. 2007 Autumn;23(4):519. PMID: 17579932.

Top Experts on “health technology assessment