Integration of ethical considerations into HTA reports: an analysis of integration levels using a systematic review

Abstract

Objective To describe the type and level of ethical integration in published health technology assessment (HTA) reports and systematically identify the ethical approaches utilized. Methods A literature search was conducted with the Google™ search engine using the keyword “ethic” between 1 January 2015 and 20 August 2019. Only HTA assessment reports with a section on ethics were retained and classified according to their level of ethical integration: no ethical analysis, ethical issues highlighted, assessments according to legal or social norms, and assessments from a moral or axiological perspective—using a qualitative methodology to distinguish such integration. Results This review yielded 188 reports with a section identified as being on ethics, produced by seventeen HTA agencies in eleven countries. One hundred and thirty-six reports did not develop an ethical analysis, thirty-one highlighted ethical issues, seventeen conducted a norm-based ethical assessment using a descriptive approach grounded in social norms, and four developed an assessment grounded in a moral or axiological perspective. The bioethical “four-principles” framework was used, but mainly for presenting ethical issues and not as a moral framework. Conclusions The majority of reports featuring a section on ethics mention ethical considerations without ethical analysis. Ethical issues are grouped with legal, social, and organizational issues and treated as contextual considerations that decision makers should be aware of. When reports present systematic norm-based ethical assessments from a descriptive perspective or ethical assessment based on a moral or axiological perspective, there is a tendency to ground these analyses in frameworks created for the purpose and reliant on a concept of ethics supporting them.

Ethical dilemmas in healthcare management: A comprehensive review

“…Decision-making frameworks are equally applicable in assessing the ethical implications of incorporating new technologies, considering patient safety, privacy, and broader societal impacts. Overall, integrating ethical models and decision-making frameworks enhances the ethical fabric of healthcare management across diverse contexts, contributing to more thoughtful, principled, and patient-centred decision-making (Legault et al, 2021).…”

We need to talk about values: a proposed framework for the articulation of normative reasoning in health technology assessment

“…HTA makes significant use of empirical evidence, but its evaluative aim is inherently normativethat is, value-based (Hofmann et al, 2014(Hofmann et al, , 2018Legault et al, 2021). The normative grounds for healthcare priority-setting are highly contested: there is little societal agreement about what constitutes a fair distribution of scarce healthcare resources.…”

“…2. Normativity in HTA: an enigmatic sphere, ambiguously described There have been many calls in the literature for increased attention to be given to the ethical dimensions of HTA (Hofmann, 2008;Saarni et al, 2008;Schokkaert, 2015;Bellemare et al, 2018;Legault et al, 2021;Oortwijn and Sampietro-Colom, 2022). However, across academic literature and in the description and practice of applied HTA, normative aspects of decision-making are described using a variety of imprecise terms, which are employed inconsistently and lack the sensitivity to distinguish between different types of normative commitment.…”