TITLE:
Ethical Evaluation in Health Technology Assessment: A Challenge for Applied Philosophy
AUTHORS:
Georges-Auguste Legault, Jean-Pierre Béland, Monelle Parent, Suzanne K.-Bédard, Christian A. Bellemare, Louise Bernier, Pierre Dagenais, Charles-Étienne Daniel, Hubert Gagnon, Johane Patenaude
KEYWORDS:
Health Technology Assessment, HTA, Ethics, Methods of Ethical Analysis, Principlism, Casuistry, Wide Reflective Equilibrium, Axiology, Triangular Model, Constructive Technology Assessment
JOURNAL NAME:
Open Journal of Philosophy,
Vol.9 No.3,
August
23,
2019
ABSTRACT: The
integration of ethical analysis in Health Technology Assessment (HTA) has
proven difficult to implement even though it is explicitly recognized as an
important component of such assessments in HTA literature. When compared to the
standardized scientific method for systematic reviews in HTA, the diversity of ethical
analysis has been characterized as a fundamental barrier to the integration of
ethics. The present paper aims to identify the theoretical and practical
differences between the approaches underpinning ethical analysis in HTA and
clarify the reasons for such diversity. Our systematic review of HTA literature
pertaining to the barriers to the integration of ethics in HTA identified nine
ethical approaches: Principlism, Casuistry, Coherence Analysis, Wide Reflective
Equilibrium, Axiology, the Socratic approach, the Triangular model,
Constructive Technology Assessment and Social Shaping of Technology. Citations
pertaining to each approach were extracted and categorized according to three
constitutive components of ethical argumentation established in a previous
research evaluating nanotechnologies: i) the disciplinary foundation that
grounds the validity of the ethical evaluation, ii) the characteristics of such
evaluation, iii) the operational process involved in applying it to a
particular case (i.e., its practical reasoning). This comparison shows that, 1) the
difference between these approaches rests primarily on their disciplinary
foundation (rooted in philosophy, philosophy/theology, or sociology), 2) their
complexity can be observed in the distinct characteristics of ethical
evaluation deriving from their differing disciplinary foundation, and 3)
although four different types of operationalization procedure were identified,
little information was available in regards to the practical reasoning associated
with these approaches.