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Di Pietro ML. Application of health technology assessment: a new need for an ethical neonatology. Eur J Pediatr 2024; 183:4179-4184. [PMID: 39136757 DOI: 10.1007/s00431-024-05620-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 05/03/2024] [Accepted: 05/18/2024] [Indexed: 09/20/2024]
Abstract
New health technologies are constantly developing. However, their impacts on health and implications for health systems are not always clear. Faced with this situation, in the last 45 years, Health Technology Assessment (HTA) has taken an important role in the decision-making process related to the implementation of technologies in healthcare systems. According to the Core Model® EUnetHTA, a "full HTA" should cover nine domains: health problems and current use of technology, description and technical characteristics, safety, clinical effectiveness, costs and economic evaluation, ethical analysis, organizational aspects, patients and social aspects, legal aspects. In all domains of a HTA, the approach is evidence-based and uses epidemiological data, systematic reviews to gather the best level of proofs regarding clinical efficacy and safety of interventions and comparators and organizational and economic models. One exception is the ethical analysis, that uses value-based approach. Although in Neonatal Intensive Care Units (NICUs) there are highly advanced technological environments, HTA has not yet been widely used in this field for determining the "value" of the diagnostic and therapeutic procedures. An example of diagnostic tool used in NICUs is the near-infrared spectroscopy (NIRS), a noninvasive device that enables real-time monitoring of the condition of peripheral tissues in critically ill newborns. The availability of this diagnostic tool could improve the choice of the most appropriate treatment to the clinical situation of the newborn. The expected benefit of NIRS motivates the need of a full HTA. Conclusion: HTA is still little used in Neonatal Critical Care, but it may be the appropriate tool to determine the "value" of technologies used in this field. The implementation of clinical trials and HTA may help in an evidence-based evaluation of new technologies for the neonatal critical care. This could facilitate the rapid introduction of the best health technologies into clinical practice. What is Known: • Health Technology Assessment (HTA) has taken an important role in the decision-making process related to the implementation of technologies in healthcare systems • The centrality of ethics in HTA has been known. In fact, ethics is everywhere in HTA, and value judgments permeate all levels of HTA What is New: • HTA is still little used in Neonatal Critical Care, but it may be the appropriate tool to determine the "value" of technologies used in this field • The implementation of clinical trials and HTA may help in an evidence-based evaluation of new technologies for the neonatal critical care and in introduction of the best and ethically acceptable health technologies into clinical practice.
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Affiliation(s)
- Maria Luisa Di Pietro
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy.
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Vandemeulebroucke T. The ethics of artificial intelligence systems in healthcare and medicine: from a local to a global perspective, and back. Pflugers Arch 2024:10.1007/s00424-024-02984-3. [PMID: 38969841 DOI: 10.1007/s00424-024-02984-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 04/30/2024] [Accepted: 06/24/2024] [Indexed: 07/07/2024]
Abstract
Artificial intelligence systems (ai-systems) (e.g. machine learning, generative artificial intelligence), in healthcare and medicine, have been received with hopes of better care quality, more efficiency, lower care costs, etc. Simultaneously, these systems have been met with reservations regarding their impacts on stakeholders' privacy, on changing power dynamics, on systemic biases, etc. Fortunately, healthcare and medicine have been guided by a multitude of ethical principles, frameworks, or approaches, which also guide the use of ai-systems in healthcare and medicine, in one form or another. Nevertheless, in this article, I argue that most of these approaches are inspired by a local isolationist view on ai-systems, here exemplified by the principlist approach. Despite positive contributions to laying out the ethical landscape of ai-systems in healthcare and medicine, such ethics approaches are too focused on a specific local healthcare and medical setting, be it a particular care relationship, a particular care organisation, or a particular society or region. By doing so, they lose sight of the global impacts ai-systems have, especially environmental impacts and related social impacts, such as increased health risks. To meet this gap, this article presents a global approach to the ethics of ai-systems in healthcare and medicine which consists of five levels of ethical impacts and analysis: individual-relational, organisational, societal, global, and historical. As such, this global approach incorporates the local isolationist view by integrating it in a wider landscape of ethical consideration so to ensure ai-systems meet the needs of everyone everywhere.
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Affiliation(s)
- Tijs Vandemeulebroucke
- Bonn Sustainable AI Lab, Institut für Wissenschaft und Ethik, Universität Bonn-University of Bonn, Bonner Talweg 57, 53113, Bonn, Germany.
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Kushniruk A, Martin-Juchat F. Patients' Information Needs Related to a Monitoring Implant for Heart Failure: Co-designed Study Based on Affect Stories. JMIR Hum Factors 2023; 10:e38096. [PMID: 36689266 PMCID: PMC9947817 DOI: 10.2196/38096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 09/28/2022] [Accepted: 10/11/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND RealWorld4Clinic is a European consortium that is currently developing an implantable monitoring device for acute heart failure prevention. OBJECTIVE This study aimed to identify the main issues and information needs related to this new cardiac implant from the patients' perspective. METHODS A total of 3 patient collaborators were recruited to help us design the study. During 4 remotely held meetings (each lasting for 2 hours), we defined the main questions and hypotheses together. Next, 26 additional interviews were conducted remotely to test these hypotheses. During both phases, we used affect stories, which are life narratives focusing on affect and the relationship between patients and the care ecosystem, to highlight the main social issues that should be addressed by the research according to the patients. RESULTS Context of diagnosis, age, and severity of illness strongly influence patient experience. However, these variables do not seem to influence the choice regarding being implanted, which relies mostly on the individual patient's trust in their physicians. It seems that the major cause of anxiety for the patient is not the implant but the disease itself, although some people may initially be concerned over the idea of becoming a cyborg. Remote monitoring of cardiac implants should draw on existing remote disease management programs focusing on a long-term relationship between the patient and their medical team. CONCLUSIONS Co-design with affect stories is a useful method for quickly identifying the main social issues related to information about a new health technology.
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Affiliation(s)
| | - Fabienne Martin-Juchat
- GRESEC - Groupe de Recherche Sur les Enjeux de la Communication, Université Grenoble Alpes, Échirolles, France
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Ghiasvand H, Barnish MS, Moradi T, Nikram E, Naghdi S. Making orphan drugs and services available and accessible for people who live with rare diseases: what has been done? a systematic scoping review. Expert Opin Orphan Drugs 2022. [DOI: 10.1080/21678707.2022.2153671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Affiliation(s)
- Hesam Ghiasvand
- Divisional Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Maxwell S. Barnish
- Peninsula Technology Assessment Group (PenTAG), University of Exeter, UK
| | - Tayebeh Moradi
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Elham Nikram
- Peninsula Technology Assessment Group (PenTAG), University of Exeter, UK
| | - Seyran Naghdi
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
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Vandemeulebroucke T, Denier Y, Mertens E, Gastmans C. Which Framework to Use? A Systematic Review of Ethical Frameworks for the Screening or Evaluation of Health Technology Innovations. SCIENCE AND ENGINEERING ETHICS 2022; 28:26. [PMID: 35639210 DOI: 10.1007/s11948-022-00377-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 04/07/2022] [Indexed: 06/15/2023]
Abstract
Innovations permeate healthcare settings on an ever-increasing scale. Health technology innovations (HTIs) impact our perceptions and experiences of health, care, disease, etc. Because of the fast pace these HTIs are being introduced in different healthcare settings, there is a growing societal consensus that these HTIs need to be governed by ethical reflection. This paper reports a systematic review of argument-based literature which focused on articles reporting on ethical frameworks to screen or evaluate HTIs. To do this a four step methodology was followed: (1) Literature search conducted in five electronic literature databases; (2) Identification of relevant articles; (3) Development of data-extraction tool to analyze the included articles; (4) Analysis, synthesis of data and reporting of results. Fifty-seven articles were included, each reporting on a specific ethical framework. These ethical frameworks existed out of characteristics which were grouped into five common ones: (1) Motivations for development and use of frameworks; (2) Objectives of using frameworks; (3) Specific characteristics of frameworks (background context, scope, and focus); (4) Ethical approaches and concepts used in the frameworks; (5) Methods to use the frameworks. Although this multiplicity of ethical frameworks shows an increasing importance of ethically analyzing HTIs, it remains unclear what the specific role is of these analyses. An ethics of caution, on which ethical frameworks rely, guides HTIs in their design, development, implementation, without questioning their technological paradigm. An ethics of desirability questions this paradigm, without guiding HTIs. In the end, a place needs to be found in-between, to critically assess HTIs.
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Affiliation(s)
- Tijs Vandemeulebroucke
- Sustainable AI Lab, Institut Für Wissenschaft Und Ethik, University of Bonn, Bonner Talweg 57, 53113, Bonn, Germany.
| | - Yvonne Denier
- Faculty of Medicine, Centre for Biomedical Ethics and Law, KU Louvain-University of Leuven, Kapucijnenvoer 35 box 7001, B-3000, Leuven, Belgium
| | - Evelyne Mertens
- Faculty of Medicine, Centre for Biomedical Ethics and Law, KU Louvain-University of Leuven, Kapucijnenvoer 35 box 7001, B-3000, Leuven, Belgium
| | - Chris Gastmans
- Faculty of Medicine, Centre for Biomedical Ethics and Law, KU Louvain-University of Leuven, Kapucijnenvoer 35 box 7001, B-3000, Leuven, Belgium
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From an Ethics of Carefulness to an Ethics of Desirability: Going Beyond Current Ethics Approaches to Sustainable AI. SUSTAINABILITY 2022. [DOI: 10.3390/su14084472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
‘Sustainable AI’ sets itself apart from other AI ethics frameworks by its inherent regard for the ecological costs of AI, a concern that has so far been woefully overlooked in the policy space. Recently, two German-based research and advocacy institutions have published a joint report on Sustainability Criteria for Artificial Intelligence. This is, to our knowledge, the first AI ethics document in the policy space that puts sustainability at the center of its considerations. We take this as an opportunity to highlight the foundational problems we see in current debates about AI ethics guidelines. Although we do believe the concept of sustainability has the potential to introduce a paradigm shift, we question whether the suggestions and conceptual grounding found in this report have the strength to usher it in. We show this by presenting this new report as an example of current approaches to AI ethics and identify the problems of this approach, which we will describe as ‘checklist ethics’ and ‘ethics of carefulness’. We argue to opt for an ‘ethics of desirability’ approach. This can be completed, we suggest, by reconceptualizing sustainability as a property of complex systems. Finally, we offer a set of indications for further research.
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Developing and Piloting a Context-Specified Ethics Framework for Health Technology Assessment: The South African Values and Ethics for Universal Health Coverage (SAVE-UHC) Approach. Int J Technol Assess Health Care 2022; 38:e26. [PMID: 35256036 DOI: 10.1017/s0266462322000113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Otto I, Kahrass H, Mertz M. "Same same but different"? On the questionable but crucial differentiation between ethical and social aspects in health technology assessment. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2021; 164:1-10. [PMID: 34301527 DOI: 10.1016/j.zefq.2021.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 05/22/2021] [Accepted: 05/25/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Within health technology assessment (HTA), the demarcation of ethical and social aspects in two separate domains is a given fact. While an overlapping of ethical and social aspects is possible, this also raises theoretical and methodological questions, such as why overlaps happen (on the basis of which understanding of ethical and social aspects), or whether they are legitimate from a methodological point of view. METHODS We analyzed, on a basis of purposive sampling, a) two well-known HTA frameworks (HTA Core Model, INTEGRATE-HTA), b) methodological literature about ethical and/or social aspects in HTA, and c) published HTA reports from the German DAHTA database and the international CRD database regarding statements on the understanding (definition/characterization) and relationship between ethical and social aspects. RESULTS The frameworks used identical definitions for ethical aspects but deviated when it comes to social aspects. Methodological papers do not always provide a definition of social and ethical aspects. In the context of ethical aspects, they often refer back to ethics as a base discipline that deals with the motives and consequences of good and bad actions for ethical aspects, while for social aspects, there is orientation towards already existing checklists and methods, without reference to a base discipline such as sociology. The analyzed HTA reports barely offered details on their understanding of ethical or social aspects (7% of n = 33). DISCUSSION The problem of defining/characterizing and differentiating ethical and social aspects exists in both theory and practice. The impression is that little attention is paid to demarcations and overlaps, and that also the methodological literature has not yet thoroughly addressed the issue. While there are also pragmatic reasons for the possible ambiguity between the ethical and the social domains, deeper epistemological issues related to the multi-/interdisciplinarity nature of HTA will have to be considered, too, such as the danger of "disciplinary capture" (pressure on some domains and their basic disciplines, e.g., ethics, to adopt the concepts and standards of other domains that are more dominant in HTA, e.g., efficacy assessment/evidenced-based medicine). CONCLUSION The domains in HTA reports should be better described epistemologically and brought into a coherent relationship with each other. This is important to avoid unreasonable overlapping and possible problematic redundancy. Further, this could help with questions of adequate expertise and methods for the processing of all relevant information for solid technology assessment.
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Affiliation(s)
- Ilvie Otto
- Institute of Ethics, History and Philosophy of Medicine, Hannover Medical School, Hannover, Germany.
| | - Hannes Kahrass
- Institute of Ethics, History and Philosophy of Medicine, Hannover Medical School, Hannover, Germany
| | - Marcel Mertz
- Institute of Ethics, History and Philosophy of Medicine, Hannover Medical School, Hannover, Germany
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BOCCALINI SARA, PARIANI ELENA, CALABRÒ GIOVANNAELISA, DE WAURE CHIARA, PANATTO DONATELLA, AMICIZIA DANIELA, LAI PIEROLUIGI, RIZZO CATERINA, AMODIO EMANUELE, VITALE FRANCESCO, CASUCCIO ALESSANDRA, DI PIETRO MARIALUISA, GALLI CRISTINA, BUBBA LAURA, PELLEGRINELLI LAURA, VILLANI LEONARDO, D’AMBROSIO FLORIANA, CAMINITI MARTA, LORENZINI ELISA, FIORETTI PAOLA, MICALE ROSANNATINDARA, FRUMENTO DAVIDE, CANTOVA ELISA, PARENTE FLAVIO, TRENTO GIACOMO, SOTTILE SARA, PUGLIESE ANDREA, BIAMONTE MASSIMILIANOALBERTO, GIORGETTI DUCCIO, MENICACCI MARCO, D’ANNA ANTONIO, AMMOSCATO CLAUDIA, LA GATTA EMANUELE, BECHINI ANGELA, BONANNI PAOLO. [Health Technology Assessment (HTA) of the introduction of influenza vaccination for Italian children with Fluenz Tetra ®]. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2021; 62:E1-E118. [PMID: 34909481 PMCID: PMC8639053 DOI: 10.15167/2421-4248/jpmh2021.62.2s1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- SARA BOCCALINI
- Dipartimento di Scienze della Salute, Università degli Studi di Firenze, Firenze, Italia
| | - ELENA PARIANI
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milano, Italia
- Centro Interuniversitario per la Ricerca sull'Influenza e le altre Infezioni Trasmissibili CIRI-IT, Italia
| | - GIOVANNA ELISA CALABRÒ
- Sezione di Igiene, Dipartimento Universitario di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Roma, Italia
- VIHTALI (Value In Health Technology and Academy for Leadership & Innovation), spin off dell’Università Cattolica del Sacro Cuore, Roma, Italia
| | - CHIARA DE WAURE
- Dipartimento di Medicina e Chirurgia, Università degli Studi di Perugia, Perugia, Italia
| | - DONATELLA PANATTO
- Centro Interuniversitario per la Ricerca sull'Influenza e le altre Infezioni Trasmissibili CIRI-IT, Italia
- Dipartimento di Scienze della Salute, Università degli Studi di Genova, Genova, Italia
| | - DANIELA AMICIZIA
- Centro Interuniversitario per la Ricerca sull'Influenza e le altre Infezioni Trasmissibili CIRI-IT, Italia
- Dipartimento di Scienze della Salute, Università degli Studi di Genova, Genova, Italia
| | - PIERO LUIGI LAI
- Centro Interuniversitario per la Ricerca sull'Influenza e le altre Infezioni Trasmissibili CIRI-IT, Italia
- Dipartimento di Scienze della Salute, Università degli Studi di Genova, Genova, Italia
| | - CATERINA RIZZO
- Area Funzionale Percorsi Clinici ed Epidemiologia, Ospedale Pediatrico Bambino Gesù, IRCCS, Roma, Italia
| | - EMANUELE AMODIO
- Dipartimento Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza “G. D'Alessandro”, Università degli Studi di Palermo, Palermo, Italia
| | - FRANCESCO VITALE
- Dipartimento Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza “G. D'Alessandro”, Università degli Studi di Palermo, Palermo, Italia
| | - ALESSANDRA CASUCCIO
- Dipartimento Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza “G. D'Alessandro”, Università degli Studi di Palermo, Palermo, Italia
| | - MARIA LUISA DI PIETRO
- Sezione di Igiene, Dipartimento Universitario di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Roma, Italia
| | - CRISTINA GALLI
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milano, Italia
| | - LAURA BUBBA
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milano, Italia
| | - LAURA PELLEGRINELLI
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milano, Italia
| | - LEONARDO VILLANI
- Sezione di Igiene, Dipartimento Universitario di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Roma, Italia
| | - FLORIANA D’AMBROSIO
- Sezione di Igiene, Dipartimento Universitario di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Roma, Italia
| | - MARTA CAMINITI
- Dipartimento di Medicina e Chirurgia, Università degli Studi di Perugia, Perugia, Italia
| | - ELISA LORENZINI
- Dipartimento di Medicina e Chirurgia, Università degli Studi di Perugia, Perugia, Italia
| | - PAOLA FIORETTI
- Dipartimento di Medicina e Chirurgia, Università degli Studi di Perugia, Perugia, Italia
| | | | - DAVIDE FRUMENTO
- Dipartimento di Scienze della Salute, Università degli Studi di Genova, Genova, Italia
| | - ELISA CANTOVA
- Dipartimento di Scienze della Salute, Università degli Studi di Genova, Genova, Italia
| | - FLAVIO PARENTE
- Dipartimento di Scienze della Salute, Università degli Studi di Genova, Genova, Italia
| | - GIACOMO TRENTO
- Dipartimento di Scienze della Salute, Università degli Studi di Genova, Genova, Italia
| | - SARA SOTTILE
- Università degli Studi di Trento, Trento, Italia
| | | | | | - DUCCIO GIORGETTI
- Dipartimento di Scienze della Salute, Università degli Studi di Firenze, Firenze, Italia
| | - MARCO MENICACCI
- Dipartimento di Scienze della Salute, Università degli Studi di Firenze, Firenze, Italia
| | - ANTONIO D’ANNA
- Dipartimento Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza “G. D'Alessandro”, Università degli Studi di Palermo, Palermo, Italia
| | - CLAUDIA AMMOSCATO
- Dipartimento Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza “G. D'Alessandro”, Università degli Studi di Palermo, Palermo, Italia
| | - EMANUELE LA GATTA
- Sezione di Igiene, Dipartimento Universitario di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Roma, Italia
| | - ANGELA BECHINI
- Dipartimento di Scienze della Salute, Università degli Studi di Firenze, Firenze, Italia
| | - PAOLO BONANNI
- Dipartimento di Scienze della Salute, Università degli Studi di Firenze, Firenze, Italia
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Vandemeulebroucke T, Dzi K, Gastmans C. Older adults' experiences with and perceptions of the use of socially assistive robots in aged care: A systematic review of quantitative evidence. Arch Gerontol Geriatr 2021; 95:104399. [PMID: 33813208 DOI: 10.1016/j.archger.2021.104399] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 03/12/2021] [Accepted: 03/16/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Socially assistive robots (SARs) are created to meet challenges of the global increase of older adults. SARs are autonomous embodied technologies, equipped with auditory and visual faculties, enabling them to interact with users while performing assistive roles. Despite studies focusing on older adults' experiences with and perceptions of SARs, it remains unclear what these encompass. OBJECTIVE To gain insight into common aspects of older adults' experiences with and perceptions of SAR use in aged care, the relevant quantitative research literature was reviewed and synthesized. METHODS Six electronic databases were searched using detailed search strings. Applying pre-specified inclusion and exclusion criteria resulted in 23 articles to be included. Full texts were analyzed thematically, and graphs were developed to facilitate comparisons. RESULTS Six main themes related to older adults' experiences with and perceptions of SAR use were identified: (1) general attitudes toward SARs, (2) feelings about SARs, (3) perceived usefulness and perceived ease of use of SARs, (4) intention to use SARs, (5) tasks of SARs, (6) SARs' appearances. Ethical issues linked to SARs were barely described in the studies. CONCLUSION Older adults are relatively open-minded about SARs, generally feeling comfortable with at least some aspects of them, and intend to use SARs in the future, especially for physical assistive functions. Thus, SARs may meet some of older ones' needs. Although the quantitative evidence contributes to gaining insight in older adults' experiences with and perceptions of SARs, social contextualization is necessary to understand their full meaning.
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Affiliation(s)
- Tijs Vandemeulebroucke
- KU Leuven - University of Leuven, Centre for Biomedical Ethics and Law, Faculty of Medicine, Kapucijnenvoer 35 box 7001, B-3000 Leuven, Belgium.
| | - Kevin Dzi
- KU Leuven - University of Leuven, Centre for Biomedical Ethics and Law, Faculty of Medicine, Kapucijnenvoer 35 box 7001, B-3000 Leuven, Belgium.
| | - Chris Gastmans
- KU Leuven - University of Leuven, Centre for Biomedical Ethics and Law, Faculty of Medicine, Kapucijnenvoer 35 box 7001, B-3000 Leuven, Belgium.
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Vandemeulebroucke T, Dierckx de Casterlé B, Gastmans C. Socially Assistive Robots in Aged Care: Ethical Orientations Beyond the Care-Romantic and Technology-Deterministic Gaze. SCIENCE AND ENGINEERING ETHICS 2021; 27:17. [PMID: 33733370 DOI: 10.1007/s11948-021-00296-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 02/25/2021] [Indexed: 06/12/2023]
Abstract
Socially Assistive Robots (SARs) are increasingly conceived as applicable tools to be used in aged care. However, the use carries many negative and positive connotations. Negative connotations come forth out of romanticized views of care practices, disregarding their already established technological nature. Positive connotations are formulated out of techno-deterministic views on SAR use, presenting it as an inevitable and necessary next step in technological development to guarantee aged care. Ethical guidance of SAR use inspired by negative connotations tends to be over-restrictive whereas positive connotations tend to provide over-permissive guidance. To avoid these extremes, we report on the development and content of 21 ethical orientations regarding SAR use in aged care. These orientations resulted from a multi-phased project, which consisted of empirical-ethical research focusing on older adults' intuitions regarding SAR use and philosophical-ethical research focusing on philosophical-ethical argumentations regarding SAR use. This project led to the Socio-historical contextualization of the ethics of SAR use, in which the ethical impact of SAR use is localized on three interrelated analysis levels: societal, organizational, and individual-relational. The 21 novel orientations regarding SAR use are structured according to these levels and further categorized into foundational and applied orientations. The first category leads to critical reflection on SAR use while the latter category inspires decision-making processes regarding this use. While going beyond the care-romantic and techno-deterministic gaze of SAR use in aged care, the described orientations balance themselves between their over-restrictiveness and over-permissiveness.
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Affiliation(s)
- Tijs Vandemeulebroucke
- Centre for Biomedical Ethics and Law, Faculty of Medicine, KU Leuven - University of Leuven, Kapucijnenvoer, 35 box 7001, 3000, Leuven, Belgium.
| | - Bernadette Dierckx de Casterlé
- Academic Centre for Nursing and Midwifery, Faculty of Medicine, KU Leuven - University of Leuven, Kapucijnenvoer, 35 box 7001, 3000, Leuven, Belgium
| | - Chris Gastmans
- Centre for Biomedical Ethics and Law, Faculty of Medicine, KU Leuven - University of Leuven, Kapucijnenvoer, 35 box 7001, 3000, Leuven, Belgium
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Bernier L, Legault GA, Daniel CÉ, K.-Bédard S, Béland JP, Bellemare CA, Dagenais P, Gagnon H, Parent M, Patenaude J. Legal Governance in HTA: Environment, Health and Safety Issues / Ethical, Legal and Social Issues (EHSI/ELSI), the Ongoing Debate. CANADIAN JOURNAL OF BIOETHICS-REVUE CANADIENNE DE BIOETHIQUE 2020. [DOI: 10.7202/1070226ar] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Garcia-Capilla DJ, Rubio-Navarro A, Torralba-Madrid MJ, Rutty J. The development of a clinical policy ethics assessment tool. Nurs Ethics 2018; 26:2259-2277. [PMID: 30318997 DOI: 10.1177/0969733018795207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Clinical policies control several aspects of clinical practice, including individual treatment and care, resource management and healthcare professionals' etiquette. This article presents Clinical Policy Ethics Assessment Tool, an ethical assessment tool for clinical policies that could be used not only by clinical ethics committees but also by policy committees or other relevant groups. AIM The aim of this study was to find or create a tool to identify ethical issues and/or confirm ethical validity in nursing practice policies, protocols and guidelines. METHODOLOGY The development of Clinical Policy Ethics Assessment Tool involved first a literature review, followed by modification of the Research Protocol Ethics Assessment Tool, which was created to identify research protocols' ethical issues, and finally, a trial of Clinical Policy Ethics Assessment Tool to ensure its reliability and validity. ETHICAL CONSIDERATION The policies analysed trialling Clinical Policy Ethics Assessment Tool were in the public domain and did not contain any confidential information. Despite that, Clinical Policy Ethics Assessment Tool also had the approval of a research ethics committee. RESULTS Research Protocol Ethics Assessment Tool was chosen as the template for a Clinical Policy Ethics Assessment Tool, to which several modifications were added to adapt it to work within a nursing practice context. Clinical Policy Ethics Assessment Tool was tested twice, which resulted in a general test-retest reliability coefficient = 0.86, r = 0.84, α1 = 0.817, α2 = 0.824 and interclass correlation coefficient = 0.874. DISCUSSION Contemporary nursing practice in a developed country is often ruled by clinical policies. The use of Clinical Policy Ethics Assessment Tool could confirm the ethical validity of those clinical practice policies, impacting on nurses' education, values and quality of care. CONCLUSION Clinical Policy Ethics Assessment Tool has the potential to detect ethical issues and facilitate the correction and improvement of clinical policies and guidelines in a structured way. This is especially so as it has shown reliability in detecting issues in clinical policies involving human participants and in encouraging policymakers to consider common ethical dilemmas in nursing practice.
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Abstract
OBJECTIVES Integration of ethics into health technology assessment (HTA) remains challenging for HTA practitioners. We conducted a systematic review on social and methodological issues related to ethical analysis in HTA. We examined: (1) reasons for integrating ethics (social needs); (2) obstacles to ethical integration; (3) concepts and processes deployed in ethical evaluation (more specifically value judgments) and critical analyses of formal experimentations of ethical evaluation in HTA. METHODS Search criteria included "ethic," "technology assessment," and "HTA". The literature search was done in Medline/Ovid, SCOPUS, CINAHL, PsycINFO, and the international HTA Database. Screening of citations, full-text screening, and data extraction were performed by two subgroups of two independent reviewers. Data extracted from articles were grouped into categories using a general inductive method. RESULTS A list of 1,646 citations remained after the removal of duplicates. Of these, 132 were fully reviewed, yielding 67 eligible articles for analysis. The social need most often reported was to inform policy decision making. The absence of shared standard models for ethical analysis was the obstacle to integration most often mentioned. Fairness and Equity and values embedded in Principlism were the values most often mentioned in relation to ethical evaluation. CONCLUSIONS Compared with the scientific experimental paradigm, there are no settled proceedings for ethics in HTA nor consensus on the role of ethical theory and ethical expertise hindering its integration. Our findings enable us to hypothesize that there exists interdependence between the three issues studied in this work and that value judgments could be their linking concept.
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Reijers W, Wright D, Brey P, Weber K, Rodrigues R, O'Sullivan D, Gordijn B. Methods for Practising Ethics in Research and Innovation: A Literature Review, Critical Analysis and Recommendations. SCIENCE AND ENGINEERING ETHICS 2018; 24:1437-1481. [PMID: 28900898 DOI: 10.1007/s11948-017-9961-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 08/14/2017] [Indexed: 06/07/2023]
Abstract
This paper provides a systematic literature review, analysis and discussion of methods that are proposed to practise ethics in research and innovation (R&I). Ethical considerations concerning the impacts of R&I are increasingly important, due to the quickening pace of technological innovation and the ubiquitous use of the outcomes of R&I processes in society. For this reason, several methods for practising ethics have been developed in different fields of R&I. The paper first of all presents a systematic search of academic sources that present and discuss such methods. Secondly, it provides a categorisation of these methods according to three main kinds: (1) ex ante methods, dealing with emerging technologies, (2) intra methods, dealing with technology design, and (3) ex post methods, dealing with ethical analysis of existing technologies. Thirdly, it discusses the methods by considering problems in the way they deal with the uncertainty of technological change, ethical technology design, the identification, analysis and resolving of ethical impacts of technologies and stakeholder participation. The results and discussion of our literature review are valuable for gaining an overview of the state of the art and serve as an outline of a future research agenda of methods for practising ethics in R&I.
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Affiliation(s)
- Wessel Reijers
- ADAPT Centre, Dublin City University, Glasnevin, Dublin 9, Ireland.
| | - David Wright
- Trilateral Research and Consulting, 72 Hammersmith Rd, London, W14, UK
| | - Philip Brey
- Department of Philosophy, University of Twente, Drienerlolaan 5, 7522NB, Enschede, The Netherlands
| | - Karsten Weber
- Institute for Social Research and Technology Assessment (IST), OTH Regensburg, Galgenbergstraße 24, 93053, Regensburg, Germany
| | - Rowena Rodrigues
- Trilateral Research and Consulting, 72 Hammersmith Rd, London, W14, UK
| | - Declan O'Sullivan
- ADAPT Centre, Department of Computer Science, Trinity College Dublin, O'Reilly Institute, Dublin 2, Ireland
| | - Bert Gordijn
- Institute of Ethics, Dublin City University, Glasnevin, Dublin 9, Ireland
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Jiménez Benito J. A meditation on technique. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2018; 93:313-314. [PMID: 29398238 DOI: 10.1016/j.oftal.2017.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 11/28/2017] [Indexed: 06/07/2023]
Affiliation(s)
- J Jiménez Benito
- Servicio de Oftalmología, Hospital Universitario de Burgos, Burgos, España.
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Colucci M, Pegoraro R. Towards a Medicine of the Invisible: bioethics and relationship in "The Little Prince". MEDICAL HUMANITIES 2017; 43:9-14. [PMID: 27470159 DOI: 10.1136/medhum-2016-010946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/29/2016] [Indexed: 06/06/2023]
Abstract
The Little Prince is one of the most famous fables. In this paper, we attempt to look at three bioethical issues through the Little Prince's eyes: the end-of-life context, the patient-physician relationship and prevention/precaution. The fable gives us the basis for a perspective we have called 'Medicine of the Invisible', which is value-focused. The Little Prince suggests that we seek the invisible-the "thing that is important", the "matters of consequence", even on a gnoseological and epistemological level-as a new type of 'clinical data' which may help to make healthcare more ethical and effective. However, this invisible is attainable only within a relationship, in which the physician needs to be tamed by the patient and the patient needs to be tamed by the physician-each one becoming responsible for the other, each one becoming himself through the dialogue with the other. Responsibility is also projected towards the future, against those threats to life that are still unseen and unknown: owning a part of the world entails the ethical imperative to act, in order to safeguard life. But, without a relationship-saturated with lived time, shared experiences, and individual's uniqueness-no meaning and no value can be given. For this reason, the Medicine of the Invisible reminds bioethics that "the thing that is important is the thing that is not seen".
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INTEGRATING ETHICS IN HEALTH TECHNOLOGY ASSESSMENT: MANY WAYS TO ROME. Int J Technol Assess Health Care 2015; 31:131-7. [DOI: 10.1017/s0266462315000276] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Objectives: The aim of this study was to identify and discuss appropriate approaches to integrate ethical inquiry in health technology assessment (HTA).Methods: The key question is how ethics can be integrated in HTA. This is addressed in two steps: by investigating what it means to integrate ethics in HTA, and by assessing how suitable the various methods in ethics are to be integrated in HTA according to these meanings of integration.Results: In the first step, we found that integrating ethics can mean that ethics is (a) subsumed under or (b) combined with other parts of the HTA process; that it can be (c) coordinated with other parts; or that (d) ethics actively interacts and changes other parts of the HTA process. For the second step, we found that the various methods in ethics have different merits with respect to the four conceptions of integration in HTA.Conclusions: Traditional approaches in moral philosophy tend to be most suited to be subsumed or combined, while processual approaches being close to the HTA or implementation process appear to be most suited to coordinated and interactive types of integration. The article provides a guide for choosing the ethics approach that appears most appropriate for the goals and process of a particular HTA.
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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; 14:203-20. [PMID: 24625039 DOI: 10.1586/14737167.2014.894464] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Despite the advances made in the development of ethical frameworks for health technology assessment (HTA), there is no clear agreement on the scope and details of a practical approach to address ethical aspects in HTA. This systematic review aimed to identify existing guidance documents for incorporation of ethics in HTA to provide an overview of their methodological features. The review identified 43 conceptual frameworks or practical guidelines, varying in their philosophical approach, structure, and comprehensiveness. They were designed for different purposes throughout the HTA process, ranging from helping HTA-producers in identification, appraisal and analysis of ethical data to supporting decision-makers in making value-sensitive decisions. They frequently promoted using analytical methods that combined normative reflection with participatory approaches. The choice of a method for collection and analysis of ethical data seems to depend on the context in which technology is being assessed, the purpose of analysis, and availability of required resources.
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Affiliation(s)
- Nazila Assasi
- Programs for Assessment of Technology in Health (PATH) Research Institute, McMaster University, Hamilton, ON, Canada
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Hofmann B. Why not integrate ethics in HTA: identification and assessment of the reasons. GMS HEALTH TECHNOLOGY ASSESSMENT 2014; 10:Doc04. [PMID: 25493101 PMCID: PMC4260057 DOI: 10.3205/hta000120] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
From the conception of HTA in the 1970s it has been argued that addressing ethical issues is an element of HTA, and many methods for integrating ethics in HTA have become available. However, despite almost 40 years with repeated intentions, only few HTA reports include ethical analysis. Why is this so? How come, ethics is a constituent part of HTA, there are many methods available, but ethics is rarely part of practical HTA work? This is the key question of this article and several reasons why ethics is not a part of HTA are identified. A) Ethicists are professional strangers in HTA. B) A common agreed methodology for integrating ethics is lacking. Ethics methodology appears to be C) deficient, D) insufficient, or E) unsuitable. F) Integrating ethics in HTA is neither efficient nor needed for successful HTA. G) Most moral issues are general, and are not specific to a given technology. H) All relevant ethical issues can be handled within other frameworks, e.g., within economics. I) Ethics can undermine or burst the foundation of HTA. Hence, there are many reasons why ethics is not an integrated part of HTA so many years after identifying ethics as constitutive to HTA. These reasons may all explain why it is so, but on closer scrutiny, they do not work as compelling arguments for not addressing ethical issues in HTA. Hence, the identified reasons may work well as explanations, but not as justifications. In order to move on from a situation of failure we can: Exclude ethics from definitions of HTA, and as a consequence, establish a separate kind of evaluation (Health Technology Evaluation – HTE). Take the existing definition seriously and actually integrate ethics in the performance of HTA practice. Amend, expand or change HTA so that ethics is more genuinely incorporated.
Which of these options to choose is open for discussion, but we need to move away from a situation where we have a definition of HTA which does not correspond with HTA practice.
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Affiliation(s)
- Bjørn Hofmann
- University College of Gjøvik, Gjøvik, Norway ; Centre for Medical Ethics, University of Oslo, Norway
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Sandman L, Heintz E. Assessment vs. appraisal of ethical aspects of health technology assessment: can the distinction be upheld? GMS HEALTH TECHNOLOGY ASSESSMENT 2014; 10:Doc05. [PMID: 25493102 PMCID: PMC4260058 DOI: 10.3205/hta000121] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
An essential component of health technology assessment (HTA) is the assessment of ethical aspects. In some healthcare contexts, tasks are strictly relegated to different expert groups: the HTA-agencies are limited to assessment of the technology and other actors within the health care sector are responsible for appraisal and recommendations. Ethical aspects of health technologies are considered with reference to values or norms in such a way that may be prescriptive, or offer guidance as to how to act or relate to the issue in question. Given this internal prescriptivity, the distinction between assessment and appraisal seems difficult to uphold, unless the scrutiny stops short of a full ethical analysis of the technology. In the present article we analyse the distinction between assessment and appraisal, using as an example ethical aspects of implementation of GPS-bracelets for people with dementia. It is concluded that for HTA-agencies with a strictly delineated assessment role, the question of how to deal with the internal prescriptivity of ethics may be confusing. A full ethical analysis might result in a definite conclusion as to whether the technology in question is ethically acceptable or not, thereby limiting choices for decision-makers, who are required to uphold certain ethical values and norms. At the same time, depending on the exact nature of such a conclusion, different action strategies can be supported. A positive appraisal within HTA could result in a decision on mandatory implementation, or funding of the technology, thereby making it available to patients, or decisions to allow and even encourage the use of the technology (even if someone else will have to fund it). A neutral appraisal, giving no definite answer as to whether implementation is recommended or not, could result in a laissez-faireattitude towards the technology. A negative appraisal could result in a decision to discourage or even prohibit implementation. This paper presents an overview of the implications of different outcomes of the ethical analysis on appraisal of the technology. It is considered important to uphold the distinction between assessment and appraisal, primarily to avoid the influence of preconceived values and political interests on the assessment. Hence, as long as it is not based on the subjective value judgments of the HTA-agency (or its representative), such an appraising conclusion would not seem to conflict with the rationale for the separation of these tasks. Moreover, it should be noted that if HTA agencies abstain from including full ethical analyses because of the risk of issuing an appraisal, they may fail to provide the best possible basis for decision-makers. Hence, we argue that as long as the ethical analysis and its conclusions are presented transparently, disclosing how well-founded the conclusions are and/or whether there are alternative conclusions, the HTA-agencies should not avoid taking the ethical analysis as close as possible to a definite conclusion.
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Affiliation(s)
- Lars Sandman
- University of Borås, Institutionen för vårdvetenskap, Borås, Sweden
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HARMONIZATION OF ETHICS IN HEALTH TECHNOLOGY ASSESSMENT: A REVISION OF THE SOCRATIC APPROACH. Int J Technol Assess Health Care 2014; 30:3-9. [DOI: 10.1017/s0266462313000688] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background: Ethics has been part of health technology assessment (HTA) from its beginning in the 1970s, and is currently part of HTA definitions. Several methods in ethics have been used in HTA. Some approaches have been developed especially for HTA, such as the Socratic approach, which has been used for a wide range of health technologies. The Socratic approach is used in several ways, and there is a need for harmonization to promote its usability and the transferability of its results. Accordingly, the objective of this study was to stimulate experts in ethics and HTA to revise the Socratic approach.Methods: Based on the current literature and experiences in applying methods in ethics, a panel of ethics experts involved in HTA critically analyzed the limitations of the Socratic approach during a face-to-face workshop. On the basis of this analysis a revision of the Socratic approach was agreed on after deliberation in several rounds through e-mail correspondence.Results: Several limitations with the Socratic approach are identified and addressed in the revised version which consists of a procedure of six steps, 7 main questions and thirty-three explanatory and guiding questions. The revised approach has a broader scope and provides more guidance than its predecessor. Methods for information retrieval have been elaborated.Conclusion: The presented revision of the Socratic approach is the result of a joint effort of experts in the field of ethics and HTA. Consensus is reached in the expert panel on an approach that is considered to be more clear, comprehensive, and applicable for addressing ethical issues in HTA.
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Palm E. An interactive ethical assessment of surveillance‐capable software within the home‐help service sector. JOURNAL OF INFORMATION COMMUNICATION & ETHICS IN SOCIETY 2013. [DOI: 10.1108/14779961311304158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Lee Y, Kim S, Kim G. Ethical assessment of national health insurance system of Korea. Asia Pac J Public Health 2012; 24:872-9. [PMID: 23093517 DOI: 10.1177/1010539512462500] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The current adverse effects of the health insurance system in Korea are considered to be problems that arise from an insufficient reflection of the notion of respecting human rights. The ethical principles most commonly suggested and used in public health are the 4 principles suggested by Beauchamp and Childress in 1994. From the perspective of the community, these 4 principles of medical ethics can be expanded to resolve problems surrounding existing social systems from a socialistic standpoint. This article describes a flexible, easy-to-use model for incorporating the 4 medical ethics principles into the National Health Insurance System (NHIS). First, the principle of respect for autonomy involves respecting the decision-making capacities of autonomous medical consumers and providers and enabling individuals to make reasoned and informed choices. Second is the principle of good practice. The government and medical institutions should act in a way that benefits the health care consumers. The principle of prohibiting bad practice involves avoiding causing health problems. The National Health Insurance Corporation and health care providers should not harm the health care consumers. Finally, the principle of justice is concerned with distributing benefits, risks, and costs fairly-that is, the notion that patients in similar positions should be treated in a similar manner. If these problems are solved, health system quality could be better and more accessible and sustainable. The ethical assessment of the NHIS could be a trial to match the 4 medical ethics principles and the NHIS. It can be applied internationally to relevant policy makers in different settings.
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Abstract
This review focuses on how surgical methods should be assessed from a health technology perspective. The use of randomized controlled trials, population based registries, systematic literature research and the recently published IDEAL method are briefly discussed.
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Affiliation(s)
- D. Bergqvist
- Department of Surgical Sciences, University Hospital, Uppsala, Sweden
| | - M. Rosén
- The Swedish Council on Health Technology Assessment and Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
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Saarni SI, Anttila H, Saarni SE, Mustajoki P, Koivukangas V, Ikonen TS, Malmivaara A. Ethical issues of obesity surgery--a health technology assessment. Obes Surg 2012; 21:1469-76. [PMID: 21479827 DOI: 10.1007/s11695-011-0386-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
New surgical technologies may challenge societal values, and their adoption may lead to ethical challenges. Despite proven cost-effectiveness, obesity (bariatric) surgery and its public funding have been questioned on ethical arguments relating to, for example, the self-inflicted or non-disease nature of obesity. Our aim was to analyze the ethical issues relevant to bariatric surgery. A comprehensive health technology assessment was conducted on bariatric surgery for morbid obesity using the EUnetHTA method, including a fully integrated ethical analysis. The ethical arguments suggesting that obesity should not be surgically treated because it is self-inflicted were rejected. Medicalization of obesity may have both positive and negative effects that impact the various stakeholders differently, thus being difficult to balance. Informing bariatric surgery patients and actively supporting their autonomy is exceptionally important, as the benefits and harms of both obesity and bariatric surgery are complex, and the outcome depends on how well the patient understands and adheres to the life-long changes in eating habits required. Justice considerations are important in organizing surgical treatment of obesity, as the obese are discriminated against in many ways and obesity is more common in socioeconomically disadvantaged populations who might have problems of access to treatments. Obesity should be treated like other diseases in health care, and obesity surgery rationed like other cost-effective treatments. Positive actions to ensure patient autonomy and just access to surgical treatments may be warranted.
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Affiliation(s)
- Samuli I Saarni
- Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki, Finland.
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Boenink M. Debating the desirability of new biomedical technologies: lessons from the introduction of breast cancer screening in the Netherlands. HEALTH CARE ANALYSIS 2012; 20:84-102. [PMID: 21499812 PMCID: PMC3277696 DOI: 10.1007/s10728-011-0173-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Health technology assessment (HTA) was developed in the 1970s and 1980s to facilitate decision making on the desirability of new biomedical technologies. Since then, many of the standard tools and methods of HTA have been criticized for their implicit normativity. At the same time research into the character of technology in practice has motivated philosophers, sociologists and anthropologists to criticize the traditional view of technology as a neutral instrument designed to perform a specific function. Such research suggests that the tools and methods of more traditional forms of HTA are often inspired by an 'instrumentalist' conception of technology that does not fit the way technology actually works. This paper explores this hypothesis for a specific case: the assessments and deliberations leading to the introduction of breast cancer screening in the Netherlands. After reconstructing this history of HTA 'in the making' the stepwise model of HTA that emerged during the process is discussed. This model was rooted indeed in an instrumentalist conception of technology. However, a more detailed reconstruction of several episodes from this history reveals how the actors already experienced the inadequacy of some of the instrumentalist presuppositions. The historical case thus shows how an instrumentalist conception of technology may result in implicit normative effects. The paper concludes that an instrumentalist view of technology is not a good starting point for HTA and briefly suggests how the fit between HTA methods and the actual character of technology in practice might be improved.
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Affiliation(s)
- Marianne Boenink
- Department of Philosophy, University of Twente, 7500 AE, Enschede, The Netherlands.
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Different methods for ethical analysis in health technology assessment: An empirical study. Int J Technol Assess Health Care 2011; 27:305-12. [DOI: 10.1017/s0266462311000444] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Objectives: Ethical analysis can highlight important ethical issues related to implementing a technology, values inherent in the technology itself, and value-decisions underlying the health technology assessment (HTA) process. Ethical analysis is a well-acknowledged part of HTA, yet seldom included in practice. One reason for this is lack of knowledge about the properties and differences between the methods available. This study compares different methods for ethical analysis within HTA.Methods: Ethical issues related to bariatric (obesity) surgery were independently evaluated using axiological, casuist, principlist, and EUnetHTA models for ethical analysis within HTA. The methods and results are presented and compared.Results: Despite varying theoretical underpinnings and practical approaches, the four methods identified similar themes: personal responsibility, self-infliction, discrimination, justice, public funding, and stakeholder involvement. The axiological and EUnetHTA models identified a wider range of arguments, whereas casuistry and principlism concentrated more on analyzing a narrower set of arguments deemed more important.Conclusions: Different methods can be successfully used for conducting ethical analysis within HTA. Although our study does not show that different methods in ethics always produce similar results, it supports the view that different methods of ethics can yield relevantly similar results. This suggests that the key conclusions of ethical analyses within HTA can be transferable between methods and countries. The systematic and transparent use of some method of ethics appears more important than the choice of the exact method.
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Tackling ethical issues in health technology assessment: A proposed framework. Int J Technol Assess Health Care 2011; 27:230-7. [DOI: 10.1017/s0266462311000250] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Objectives: Values are intrinsic to the use of health technology assessments (HTAs) in health policy, but neglecting value assumptions in HTA makes their results appear more robust or normatively neutral than may be the case. Results of a 2003 survey by the International Network of Agencies for Health Technology Assessment (INAHTA) revealed the existence of disparate methods for making values and ethical issues explicit when conducting HTA.Methods: An Ethics Working Group, with representation from sixteen agencies, was established to develop a framework for addressing ethical issues in HTA. Using an iterative approach, with email exchanges and face-to-face workshops, a report on Handling Ethical Issues was produced.Results: This study describes the development process and the agreed upon framework for reflexive ethical analysis that aims to uncover and explore the ethical implications of technologies through an integrated, context-sensitive approach and situates the proposed framework within previous work in the development of ethics analysis in HTA.Conclusions: It is important that methodological approaches to address ethical reflection in HTA be integrative and context sensitive. The question-based approach described and recommended here is meant to elicit this type of reflection in a way that can be used by HTA agencies. The questions proposed are considered only as a starting point for handling ethics issues, but their use would represent a significant improvement over much of the existing practice.
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Nielsen CP, Funch TM, Kristensen FB. Health technology assessment: Research trends and future priorities in Europe. J Health Serv Res Policy 2011; 16 Suppl 2:6-15. [DOI: 10.1258/jhsrp.2011.011050] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objective: To provide an overview of health services research related to health technology assessment (HTA) and to identify research priorities from a European perspective. Methods: Several methods were used: systematic review of articles indexed with the MeSH term ‘technology assessment’ in PubMed from February 1999-2009; online survey among experts; and conference workshop discussions. Results: Research activity in HTA varies considerably across Europe. The research was categorised into six areas: (1) the breadth of analysis in HTA (such as economic, organizational and social aspects); (2) HTA products developed to meet the needs of policy-makers (such as horizon scanning, mini-HTA, and core HTA); (3) handling life-cycle perspectives in relation to technologies; (4) topics that challenge existing methods and for which HTA should be developed to address the themes more comprehensively (such as public health interventions and organizational interventions); (5) development of HTA capacity and programmes; and (6) links between policy and HTA. An online survey showed that the three areas that were given priority were the relationship between HTA and policy-making (71%), the impact of HTA (62%) and incorporating patient aspects in HTA (50%). Policy-makers highlighted HTA and innovation processes as their main research priority (42%). Areas that the systematic review identified as future priorities include issues within the six existing research areas such as disinvestment, developing evidence for new technologies, assessing the wider effects of technology use, and determining how HTA affects decision-making. In addition, relative effectiveness and individualized treatments are areas of growing interest. Conclusions: The research priorities identified are important for obtaining high quality and cost-effective health care in Europe. Managing the introduction, use and phasing out of technologies challenges health services throughout Europe, and these processes need to be improved to successfully manage future more general challenges. An ageing population and a diminishing workforce both require strong efforts to ensure effective and well-organized use of human resources and technologies. Furthermore, Europe needs to focus on innovation. This is closely linked to use of technologies and calls for future research.
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Eliciting ethical and social values in health technology assessment: A participatory approach. Soc Sci Med 2011; 73:135-44. [DOI: 10.1016/j.socscimed.2011.04.017] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2010] [Revised: 04/08/2011] [Accepted: 04/13/2011] [Indexed: 11/20/2022]
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Abstract
Objectives: The aim of this study was to critically examine the current guidance for conducting ethics analysis in health technology assessment (HTA) and to offer recommendations for how to improve this practice.Methods: MEDLINE, Philosopher's Index, and Google Scholar were searched for articles and reports using the keywords “ethics” and “health technology assessment” and related terms. Bibliographies of all relevant articles were also examined for additional references. A philosophical analysis of the existing guidance was conducted.Results: We offer three recommendations for improving ethics analysis in HTA. First, ethical and legal issues must be clearly separated so that all policy-relevant questions that the technology raises can be considered clearly and systematically. Second, analysts must make better use of ethics theory and discuss better how particular theoretical approaches and associated analytic tools are selected to make transparent which alternative approaches were considered and why they were rejected. Third, the necessity for philosophical expertise to adequately conduct ethics analysis needs to be acknowledged.Conclusions: To act on these recommendations for ethics analysis, we offer these three steps forward: acknowledge and use relevant expertise, further develop models for conducting and reporting ethics analyses, and make use of untapped resources in the literature.
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Moving cautiously: Public involvement and the health technology assessment community. Int J Technol Assess Health Care 2011; 27:43-9. [DOI: 10.1017/s0266462310001200] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objectives: This study explores the factors that enhance or reduce the prospects for public involvement in the activities of health technology assessment (HTA) agencies.Methods: The analytical framework for this study is based on the work of John W. Kingdon, which provides a comprehensive synthesis of the factors influencing governments and public organizations' agenda. The study draws insights from forty-two semistructured telephone interviews with informants involved in international HTA networks and/or in HTA agencies in Canada, Denmark, and the United Kingdom.Results: This exploratory study suggests that the HTA community is moving toward greater public involvement. However, the HTA community remains cautious and ambivalent about the technical feasibility of public involvement, its acceptability to policy makers and practitioners, and its impacts on HTA agencies' resources and procedures.Conclusions: The study stresses the importance of conducting rigorous and compelling evaluations to inform HTA agencies' decision to adopt, or reject, public involvement practices.
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“It all depends”: Conceptualizing public involvement in the context of health technology assessment agencies. Soc Sci Med 2010; 70:1518-26. [DOI: 10.1016/j.socscimed.2010.01.036] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2009] [Revised: 01/14/2010] [Accepted: 01/24/2010] [Indexed: 11/21/2022]
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Sacchini D, Virdis A, Refolo P, Pennacchini M, de Paula IC. Health technology assessment (HTA): ethical aspects. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2009; 12:453-457. [PMID: 19507050 DOI: 10.1007/s11019-009-9206-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2009] [Accepted: 05/15/2009] [Indexed: 05/27/2023]
Abstract
"HTA is a multidisciplinary process that summarizes information about the medical, social, economic and ethical issues related to the use of a health technology in a systematic, transparent, unbiased, robust manner. Its aim is to inform the formulation of safe, effective, health policies that are patient focused, and seek to achieve best value" (EUnetHTA 2007). Even though the assessment of ethical aspects of a health technology is listed as one of the objectives of a HTA process, in practice, the integration of these dimensions into reports remains limited. The article is focused on four points: 1. the HTA concept; 2. the difficult HTA-ethics relationship; 3. the ethical issues in HTA; 4. the methods for integrating ethical analysis into HTA.
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Affiliation(s)
- Dario Sacchini
- Institute of Bioethics, A. Gemelli School of Medicine, Università Cattolica del Sacro Cuore, Largo F. Vito, 1, 00168, Rome, Italy.
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Guidance for considering ethical, legal, and social issues in health technology assessment: application to genetic screening. Int J Technol Assess Health Care 2008; 24:412-22. [PMID: 18828935 DOI: 10.1017/s0266462308080549] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES AND METHODS Many authors have argued that ethical, legal, and social issues ("ELSIs") should be explicitly integrated into health technology assessment (HTA), yet doing so poses challenges. This discussion may be particularly salient for technologies viewed as ethically complex, such as genetic screening. Here we provide a brief overview of contemporary discussions of the issues from the HTA literature. We then describe key existing policy evaluation frameworks in the fields of disease screening and public health genomics. Finally, we map the insights from the HTA literature to the policy evaluation frameworks, with discussion of the implications for HTA in genetic screening. RESULTS AND CONCLUSIONS A critical discussion in the HTA literature considers the definition of ELSIs in HTA, highlighting the importance of thinking beyond ELSIs as impacts of technology. Existing HTA guidance on integrating ELSIs relates to three broad approaches: literature synthesis, involvement of experts, and consideration of stakeholder values. The thirteen key policy evaluation frameworks relating to disease screening and public health genomics identified a range of ELSIs relevant to genetic screening. Beyond straightforward impacts of screening, these ELSIs require consideration of factors such as the social and political context surrounding policy decisions. The three broad approaches to addressing ELSIs described above are apparent in the screening/genomics literatures. In integrating these findings we suggest that the method chosen for addressing ELSIs in HTA for genetic screening may determine which ELSIs are prioritized; and that an important challenge is the lack of guidance for evaluating such methods.
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Saarni SI, Hofmann B, Lampe K, Lühmann D, Mäkelä M, Velasco-Garrido M, Autti-Rämö I. Ethical analysis to improve decision-making on health technologies. Bull World Health Organ 2008; 86:617-23. [PMID: 18797620 DOI: 10.2471/blt.08.051078] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2008] [Accepted: 06/03/2008] [Indexed: 11/27/2022] Open
Abstract
Health technology assessment (HTA) is the multidisciplinary study of the implications of the development, diffusion and use of health technologies. It supports health-policy decisions by providing a joint knowledge base for decision-makers. To increase its policy relevance, HTA tries to extend beyond effectiveness and costs to also considering the social, organizational and ethical implications of technologies. However, a commonly accepted method for analysing the ethical aspects of health technologies is lacking. This paper describes a model for ethical analysis of health technology that is easy and flexible to use in different organizational settings and cultures. The model is part of the EUnetHTA project, which focuses on the transferability of HTAs between countries. The EUnetHTA ethics model is based on the insight that the whole HTA process is value laden. It is not sufficient to only analyse the ethical consequences of a technology, but also the ethical issues of the whole HTA process must be considered. Selection of assessment topics, methods and outcomes is essentially a value-laden decision. Health technologies may challenge moral or cultural values and beliefs, and their implementation may also have significant impact on people other than the patient. These are essential considerations for health policy. The ethics model is structured around key ethical questions rather than philosophical theories, to be applicable to different cultures and usable by non-philosophers. Integrating ethical considerations into HTA can improve the relevance of technology assessments for health care and health policy in both developed and developing countries.
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Affiliation(s)
- Samuli I Saarni
- Finnish Office for Health Technology Assessment, National Research and Development Centre for Welfare and Health, Helsinki, Finland.
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Abstract
From the heydays of HTA in the 1970s, it has been argued that ethics should be a part of HTA. Despite more than 30 years with repeated intentions, only few HTA reports include ethical analysis, and there is little agreement on methods for integrating ethics. This poses the question of why it is so important to integrate ethics in HTA? The article analyzes ten arguments for making ethics part of HTA. The validity of the arguments depend on what we mean by “integrating,” “ethics,” and “HTA.” Some of the counterarguments explain why it has taken so long to integrate ethics in HTA and why there are so many ethical approaches. Nevertheless, some of the arguments for making ethics part of HTA appear to be compelling. Health care is a moral endeavor, and the vast potential of technology poses complex moral challenges. A thorough assessment of technology would include reflection on these moral aspects. Ethics provides such a moral reflection. Health technology is a way to improve the life of human individuals. This involves questions of what “the good life” is, and hence ethical issues. Trying to ignore such questions may inflict with the moral foundation of health care: to help people. Additionally, HTA is anevaluation, and as such also a reflection on values. Hence, there is a profound affinity between HTA and ethics. Accordingly, ethics cannot be “integrated” in HTA as ethics is already a constitutive part of HTA. However, ethics can be acknowledged and emphasized.
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Droste S. Systematische Gewinnung von Informationen zu ethischen Aspekten in HTA-Berichten zu medizinischen Technologien bzw. Interventionen. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2008; 102:329-41. [DOI: 10.1016/j.zefq.2008.03.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Herborg H, Haugbølle LS, Lee A. Automated dose dispensing in Danish primary health care - a technology under construction. Pharm Pract (Granada) 2008; 6:103-12. [PMID: 25157289 PMCID: PMC4141873 DOI: 10.4321/s1886-36552008000200008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2007] [Accepted: 06/06/2008] [Indexed: 11/24/2022] Open
Abstract
Objectives The purpose of this study was to conduct a health technology assessment (HTA) of automated dose dispensing in the Danish primary health care sector. The present article answers the sub question of how various groups of actors spoke about and understood the shaping of automated dose dispensing (positioning in discourses). Methods The project utilized two methods: 11 qualitative research interviews with selected key actors and a net-based qualitative questionnaire of 97 selected practitioners. Results Three main types of discourse were identified with respect to the development of automated dose dispensing, namely ‘optimistic’, ‘sceptical’ and ‘pragmatic’. A wide diversity of opinion about automated dose dispensing was identified among the three discourses and their attendant scenarios. A number of factors are found in all three types of discourse, and are therefore considered to express common recommendations for decision makers and practitioners. These factors are described in the article. Conclusions The article argues in favour of HTA, which to a great extent clarifies and initiates the perspectives of various groups of actors about the same technology. Our analyses show that conscious strategies must be employed to make the technology work successfully with the actors involved. The preferences, ideas and proposals for future actions and initiatives identified in the project could be the basis for defining future development strategies.
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Affiliation(s)
| | - Lotte S Haugbølle
- Department of Pharmacology and Pharmacotherapy and Research Center for Quality in Medicine Use (FKL-center), Faculty of Pharmacy, Copenhagen University ( Denmark )
| | - Anne Lee
- Research Consultant, Centre for Applied Health Services Research and Technology Assessment, Southern University of Denmark ( Denmark )
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Marian F. Medical Pluralism: Global Perspectives on Equity Issues. Complement Med Res 2008; 14 Suppl 2:10-8. [DOI: 10.1159/000112319] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Over the last decades, awareness has increased about
the phenomenon of medical pluralism and the importance
to integrate biomedicine and other forms of health
care. The broad variety of healing cultures existing
alongside biomedicine is called complementary or alternative
medicine (CAM) in industrialized countries and
traditional medicine (TM) in developing countries. Considerable
debate has arisen about ethical problems related
to the growing use of CAM in industrialized countries.
This article focuses on equity issues and aims to consider
them from a global perspective of medical pluralism.
Several dimensions of equity are explored and their interrelatedness
discussed: access to care, research (paradigm
and founding) and recognition. This so-called ‘equity
circle’ is then related to Iris Marion Young’s justice
theory and particularly to the concepts of cultural imperialism,
powerlessness and marginalisation.
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Boos N. Health care technology assessment and transfer. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2007; 16:1291-2. [PMID: 17636348 PMCID: PMC2200781 DOI: 10.1007/s00586-007-0440-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/02/2007] [Indexed: 11/30/2022]
Affiliation(s)
- Norbert Boos
- Centre for Spinal Surgery, University of Zurich, Uniklinik Balgrist, Forchstrasse 340, 8008 Zurich, Switzerland
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Lehoux P, Williams-Jones B. Mapping the integration of social and ethical issues in health technology assessment. Int J Technol Assess Health Care 2007; 23:9-16. [PMID: 17234011 DOI: 10.1017/s0266462307051513] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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 technologyandHTA are made explicit.
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Affiliation(s)
- Pascale Lehoux
- Department of Social and Preventive Medicine, University of Montreal, Branch Centre-ville, Montreal, Quebec, Canada.
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Braunack-Mayer AJ. Ethics and health technology assessment: handmaiden and/or critic? Int J Technol Assess Health Care 2006; 22:307-12. [PMID: 16984058 DOI: 10.1017/s0266462306051191] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES This study examines the content and role of ethical analysis in health technology assessment (HTA) and horizon scanning publications. It proposes that ethical analysis in HTA is of at least two different types: an ethics of HTA and an ethics in HTA. METHODS I examine the critical differences between these approaches through the examples of the analysis of genetic screening for breast cancer and home blood glucose testing in diabetes. I then argue that, although both approaches subscribe to similar views concerning HTA and ethics, they use different theoretical and methodological traditions to interpret and explain them. RESULTS AND CONCLUSIONS I conclude by suggesting that we need the interpretive insights of both these approaches, taken together, to explain why ethics has not been able yet to contribute fully to HTA and to demonstrate the scope and complexity of ethical work in this domain.
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Marian F, Widmer M, Herren S, Dönges A, Busato A. Physicians’ Philosophy of Care: A Comparison of Complementary and Conventional Medicine. Complement Med Res 2006; 13:70-7. [PMID: 16645286 DOI: 10.1159/000090735] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND This project is part of an evaluation of complementary and alternative medicine (CAM) aimed at providing a scientific basis for the Swiss Government to include 5 CAM methods in basic health coverage: anthroposophic medicine, homeopathy, neural therapy, phytotherapy and Traditional Chinese Medicine (TCM). OBJECTIVES The objective was to explore the philosophy of care (convictions and values, priorities in medical activity, motivation for CAM, criteria for the practice of CAM, limits of the used methods) of conventional and CAM general practitioners (GPs) and to determine differences between both groups. MATERIALS AND METHODS This study was a cross-sectional survey of a representative sample of 623 GPs who provide complementary or conventional primary care. A mailed questionnaire with open-ended questions focusing on the philosophy of care was used for data collection. An appropriate methodology using a combination of quantitative and qualitative approaches was developed. RESULTS Significant differences between both groups include philosophy of care (holistic versus positivistic approaches), motivation for CAM (intrinsic versus extrinsic) and priorities in medical activity. Both groups seem to be aware of limitations of the therapeutic methods used. The study reveals that conventional physicians are also using complementary medicine. DISCUSSION Our study provides a wealth of data documenting several aspects of physicians' philosophy of care as well as differences and similarities between conventional and complementary care. Implications of the study with regard to quality of care as well as ethical and health policy issues should be investigated further.
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Affiliation(s)
- Florica Marian
- Institute for Complementary Medicine KIKOM, Inselspital, Bern, Switzerland.
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