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.
Highlights
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
The aim of our analysis is to show, based on the Health Technological Assessment (HTA) literature, how a decision-making paradigm based on the structure of the value judgments could provide a better understanding of the value-ladenness of the HTA process
Data from the selected quotes were identified by the two independent researchers and recorded in a structured data collection sheet representing: 1) the different steps of decision-making in HTA, 2) the description of their inherent implicit value judgments made explicit, 3) the criteria that grounds the attribution of the value to the facts considered, and 4) references to the quotes found in the HTA literature
Summary
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. As there exists no standardized procedure for the HTA process due to the different types of mandates found throughout the various HTA agencies and countries around the world, we systematized the HTA decision steps according to the procedure implemented by our local hospital-based HTA unit (UETMISSS of CHUS, Sherbrooke, QC, Canada) with the participation of local HTA evaluators involved as co-investigators in this research (Bellemare et al, 2017) This procedure was itself inspired in part by the work of others (Busse et al, 2002; European Network for Health Technology Assessment (EUnetHTA), 2016; Kristensen & Sigmund, 2007). Data from the selected quotes were identified by the two independent researchers and recorded in a structured data collection sheet representing: 1) the different steps of decision-making in HTA, 2) the description of their inherent implicit value judgments (evaluation) made explicit, 3) the criteria that grounds the attribution of the value to the facts considered, and 4) references to the quotes found in the HTA literature.
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