TITLE:
Eliciting Value-Judgments in Health Technology Assessment: An Applied Ethics Decision Making Paradigm
AUTHORS:
Georges-Auguste Legault, Suzanne K.-Bédard, Jean-Pierre Béland, Christian A. Bellemare, Louise Bernier, Pierre Dagenais, Charles-Étienne Daniel, Hubert Gagnon, Monelle Parent, Johane Patenaude
KEYWORDS:
Applied Ethics, Health Technology Assessment, Decision-Making Paradigm, Value Judgments, Values
JOURNAL NAME:
Open Journal of Philosophy,
Vol.11 No.2,
May
14,
2021
ABSTRACT: The worldwide COVID-19 pandemic has shed more light on the difficulty of
making health care decisions integrating scientific knowledge and values
associated to life and death issues, human suffering, quality of life, economic
losses, liberty of movement, etc. But the difficulties related to health care
decisions and the use of innovative drugs or technologies are not new, and many
countries have created agencies that have the mandate to evaluate new
technologies in health care. Health Technological Assessment (HTA) reports’ aim
is to guide the decision makers in these difficult matters. There are two
ethical components in HTA. The first is the report’s presentation of an ethical
evaluation of the technology. The second is the value-ladenness of the HTA
decision-making process itself. When implicit value judgments are not elicited,
the justification of the final decision cannot be transparent. The present
paper aims to identify and elicit the implicit value-judgments related to each
step of the HTA process. This research is grounded on an applied ethics decision-making paradigm based on the role of value judgments in
the decision-making process. The first part discusses two different approaches
to values and value judgments in HTA. In the second part, citations mentioning
value judgments extracted from a systematic review on the integration of ethics
into HTA were categorized to elicit the value judgments and their criteria for
each different HTA decision-making steps. The results show that there are 18
decision-making steps in the HTA process where 23 implicit value-judgments can
be recognized. The range of these value judgments encompasses the whole
HTA process: from the initial request, the presenting of the principal issues,
to the final report’s dissemination. Since stakeholders need to understand
which value judgments the conclusion of a report relies on, eliciting the
implicit value judgments in the HTA decision-making process should yield more
transparency.