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Integrating ethical enquiry and health technology assessment: limits and opportunities for efficiency and equity

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Poiesis & Praxis

Abstract

This paper aims at discussing some contributions, limitations and opportunities that efficiency and equity studies could make to form a better understanding of ethical issues involved in health technology assessment (HTA). Prenatal detection of Down syndrome is used as a case study for further discussions regarding efficiency and equity, as well as other ethical principles including beneficence, non-maleficence and autonomy. The development and use of adequate methods and the need for context appraisal are two imperative issues in this field of knowledge. The analysis of ethical implications in HTA should account for both. Economic evaluation methodologies have great potential in the assessment of some key ethical principles such as efficiency and equity but are of limited use concerning other fundamental principles. Social and individual values play a prominent role in this respect.

Zusammenfassung

Dieser Artikel zielt darauf ab, Beiträge zu diskutieren, die Effizienz- und Verteilungsstudien zu einem besseren Verständnis der ethischen Fragen in der Technologiefolgenabschätzung im Gesundheitssektor (HTA) leisten könnten, und ihre Möglichkeiten und Begrenzungen zu erhellen. Pränatale Diagnose des Down-Syndroms dient hier als Fallstudie für weitere Diskussionen hinsichtlich Effizienz und Verteilung sowie andere ethische Prinzipien, darunter Wohltätigkeit (beneficence), die Pflicht, keinen Schaden zuzufügen (non-maleficence) und Autonomie. Die Entwicklung sowie Anwendung geeigneter Methoden und die Bereitstellung der notwendigen Kontextbeurteilung sind zwei dringende Fragen auf diesem Wissensgebiet. Die Analyse ethischer Aspekte in der HTA sollte beiden Rechnung tragen. Wirtschaftswissenschaftliche Auswertemethoden haben ein erhebliches Potential für die Beurteilung einzelner ethischer Schlüsselfragen, z. B. Effizienz oder Verteilung, sind jedoch nur von begrenztem Nutzen in Bezug auf andere fundamentale Prinzipien. Gesellschaftliche und individuelle Wertvorstellungen spielen hier eine herausragende Rolle.

Résumé

Cet article s’interroge sur les contributions, restrictions et possibilités que les études d’efficacité et d’équité pourraient apporter pour une meilleure compréhension des questions éthiques qui découlent de l’ETS (évaluation des technologies de la santé). La détection prénatale du syndrome de Down sert d’étude de cas pour d’autres discussions concernant l’efficacité, l’équité, de même que d’autres principes éthiques, notamment le caractère bénéfique ou non pernicieux et l’autonomie. Le développement et l’utilisation de méthodes adéquates et le besoin d’évaluation dans le contexte sont deux aspects urgents dans ce domaine du savoir. L’analyse des implications éthiques dans l’ETS devrait prendre l’un et l’autre en compte. Les méthodes d’évaluation économique renferment un fort potentiel pour l’évaluation de certains principes éthiques clés, tels que l’efficacité et l’équité, mais sont d’une utilité réduite en liaison avec d’autres principes fondamentaux. Les valeurs sociales et individuelles jouent un rôle éminent à cet égard.

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Notes

  1. Other types of studies and methods such as quality of life studies, cost of illness studies, decision analysis techniques, financial analysis, modelling techniques, and socio-economic studies, could also be of relevance to the analysis.

  2. Decision analysis is a structured, explicit, and quantitative methodological tool that makes possible the quantification of selected outcomes associated with different courses of action in conditions of uncertainty. A decision analysis model represents, graphically and chronologically, the different events and consequences of each screening program.

  3. Since health needs have been described as situations in which individuals are placed in reference to a given standard, and those falling under such a standard are said to be ‘in need’, need is frequently defined in terms of ill health. Different degrees of ill health reflect different medical needs, and people in the same degree of ill health are said to have the same need.

  4. As stated at the beginning of this paper, equity is both concerned with the delivery and the finance of services. Equity considerations regarding the finance of services would ideally look into who is paying for those services and whether or not there exists a socio-economic gradient.

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  1. University of Barcelona, Departament de Sociologia i Analisi de les Organitzacions, Tinent Coronel Valenzuela 1--11, Torre 4 Depatx 4117, 08034, Barcelona, Spain

    Pedro Gallo

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Ethical axioms are found and tested not very differently from the axioms of science. Truth is what stands the test of experience. Albert Einstein (1879–1955)

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Gallo, P. Integrating ethical enquiry and health technology assessment: limits and opportunities for efficiency and equity. Poiesis Prax 2, 103–117 (2004). https://doi.org/10.1007/s10202-003-0048-z

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