Public Policy Systems Dealing with Ethically Contested Medical Technological Innovations

Abstract

The questions tackled in this paper are: How do we deal with ethically contested medical innovations?, and Can we do better? First, I analyse how we deal with these problems by a division of labour and competitive boundary work between the medical R&D system's research and technological imperative, the medical profession's claim to self‐regulation and health policy‐makers’ claim to political primacy and an incrementalist style of policy making. Second, turning to the normative question, I propose that policy‐makers shift to a primacy of problems. Different types of problems demand different types of policy‐making systems and styles. Thus, policy‐makers could commence designing a health policy‐making system robust enough to adequately deal with non‐incremental but ethically contested medical innovations. I argue for medical innovation which also takes ethical, social and legal issues into account. This may be achieved by turning political competition through venue shopping into meta‐governance through deliberate venue choice. This requires deliberative and participatory design elements in procedures and spaces for health technology assessment.