Hostname: page-component-5b777bbd6c-cp4x8 Total loading time: 0 Render date: 2025-06-23T12:09:32.735Z Has data issue: false hasContentIssue false
  • English
  • Français

Ethical Issues in Technology Assessment: Conceptual Categories and Procedural Considerations

Published online by Cambridge University Press:  10 March 2009

Elizabeth Heitman
Elizabeth Heitman
Affiliation:
The University of Texas-Houston School of Public Health
Get access Rights & Permissions [Opens in a new window]

Abstract

The practice of health care technology assessment involves ethical considerations in all of its varied functions and techniques. Ethical issues in technology assessment can be grouped into the broad categories of normative concepts, diagnosis, prevention and therapy, research and the advancement of knowledge, and allocation of resources. Moreover, the ethics of the assessment process itself must be evaluated in terms of the integrity of the project's goals, procedures, and effects, and evaluators’ open and self-critical acknowledgment of their purposes. As a relatively new field, technology assessment can benefit from using a variety of analytic approaches as it works to develop its own methods for evaluating ethical issues related to technology.

Type
General Essays
Information
International Journal of Technology Assessment in Health Care , Volume 14 , Issue 3 , Summer 1998 , pp. 544 - 566
Copyright
Copyright © Cambridge University Press 1998

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

REFERENCES

1.Angell, M.Science on Trial. New York: W. W. Norton & Co., 1996.Google Scholar
2.Angell, M., & Kassirer, J. P.Clinical research: What should the public believe? New England Journal of Medicine, 1984, 331, 189–90.CrossRefGoogle Scholar
3.Antczak-Bouckoms, A., Burdick, E., Klawansky, S., & Mosteller, F.Using medical registries and data sets for technology assessment. International Journal of Technology Assessment in Health Care, 1991, 7, 123–28.CrossRefGoogle ScholarPubMed
4.Applebaum, P. S., Roth, L. H., Lidz, C. W., Benson, P., & Winslade, W.False hopes and best data: Consent to research and the therapeutic misconception. Hastings Center Report, 1987, 17 (04), 20–24.CrossRefGoogle Scholar
5.Bailar, J. C., III. Science, statistics, and deception. Annals of Internal Medicine, 1986, 104, 259–60.CrossRefGoogle ScholarPubMed
6.Banta, H. D., & Thacker, S. B.The case for reassessment of health care technology: Once is not enough. JAMA, 1990, 264, 235–40.CrossRefGoogle ScholarPubMed
7.Barber, B.Resistance by scientists to scientific discovery. Science, 1961, 134, 596–602.CrossRefGoogle ScholarPubMed
8.Baue, A. E.Peer and/or peerless review: Some vagaries of the editorial process. Archives of Surgery, 1985, 120, 885–88.CrossRefGoogle ScholarPubMed
9.Baum, M.American and European recommendations for screening mammography in younger women: A cultural divide? British Medical Journal, 1993, 307, 1481–83.Google Scholar
10.Beauchamp, T. L., & Childress, J. F.Principles of biomedical ethics, 4th ed.New York: Oxford University Press, 1993.Google Scholar
11.Bennett, J. C., for the Board on Health Sciences Policy of the Institute of Medicine. Inclusion of women in clinical trials: Policies for population subgroups. New England Journal of Medicine, 1993, 329, 288–92.CrossRefGoogle Scholar
12.Blendon, R. J., & Donelan, K.Discrimination against people with AIDS: The public's perspective. New England Journal of Medicine, 1988, 319, 1022–26.CrossRefGoogle ScholarPubMed
13.Borzo, G.Managed care and technology assessment: Who should pay? AMA Technology News, 1996, 9, 3–4.Google Scholar
14.Bronsino, J. D., Smith, V. H., & Wade, M. L.Medical technology and society: An interdisciplinary perspective. New York: McGraw Hill Publishing Co., 1991, 509–19.Google Scholar
15.Bulleit, T. N. Jr., & Bonnet, S. M.Technology transfer: Trends in the federalization of biomedical research. Academic Medicine, 1996, 71, 709–15.CrossRefGoogle ScholarPubMed
16.Chalmers, T. C., Frank, C. S., & Reitman, D. R.Minimizing the three stages of publication bias. JAMA, 1990, 263, 1392–95.CrossRefGoogle ScholarPubMed
17.Comroe, J. J. Jr., & Dripps, R. D.Scientific basis for the support of biomedical science. Science, 1976, 192, 105–11.CrossRefGoogle ScholarPubMed
18.Coughlin, S. S., & Beauchamp, T. L.Historical foundations. In Ethics and epidemiology. New York: Oxford University Press, 1995, 5–23.Google Scholar
19.Council on International Organizations of Medical Science. International ethical guidelines for biomedical research involving human subjects. Geneva, Switzerland: CIOMS, 1993.Google Scholar
20.Council on International Organizations of Medical Science. International guidelines for ethical review of epidemiological studies. Geneva, Switzerland: CIOMS, 1991.Google Scholar
21.DeBakey, M. E.Medical centers of excellence and health reform. Science, 1993, 262, 523–25.CrossRefGoogle ScholarPubMed
22.DeWitt, M. D., & Gostin, L. O.Conflict of interest dilemmas in biomedical research. JAMA, 1994, 271, 547–51.Google Scholar
23.Donaldson, M. S., & Sox, H. C. Jr. (eds.). Setting priorities for health technology assessment: A model process. Washington, DC: National Academy Press, 1992.Google Scholar
24.Doughtery, C. J.Ethical perspectives on prospective payment. Hastings Center Report, 1989, 19 (01/02), 5–11.Google Scholar
25.Drummond, M. F., O'Brien, B. J., Stoddart, G. L., & Torrance, G. W.Methods for the economic evaluation of health care programmes, 2nd ed.Oxford, UK: Oxford University Press, 1997.Google Scholar
26.DuBose, E. R., Hamel, R., & O'Connell, L. J. (eds.). A matter of principles? Ferment in U.S. bioethics. Valley Forge, PA: Trinity Press International, 1994.Google Scholar
27.Engelhardt, H. T. Jr.Ethics in pluralist societies. Perspectives in Biology and Medicine, 1982, 26, 64–78.CrossRefGoogle ScholarPubMed
28.Engelhardt, H. T. Jr.The disease of masturbation, values and the concept of disease. Bulletin of the History of Medicine, 1974, 48, 234–48.Google ScholarPubMed
29.Fox, E., & Stocking, C.Ethics consultants' recommendations for life-prolonging treatment of patients in a persistent vegetative state. JAMA, 1993, 270, 2578–82.CrossRefGoogle Scholar
30.Frank, J. D.Galloping technologies: A new social disease. In Iannone, A. P. (ed.), Contemporary moral controversies in technology. New York: Oxford University Press, 1987, 17–26.Google Scholar
31.Freedman, B.Equipoise and the ethics of clinical research. New England Journal of Medicine, 1987, 317, 141–45.CrossRefGoogle ScholarPubMed
32.Fuchs, V.Who shall live? Health, economics, and social choice. New York: Basic Books, 1974.Google Scholar
33.Goodman, C.A basic methodology toolkit. In Assessment of health care technologies: Case studies, key concepts and strategic issues. Chichester: John Wiley & Sons, 1996, 29–65.Google Scholar
34.Goodman, C. S.Literature searching and evidence interpretation for assessing health care practices. Stockholm, Sweden: Swedish Council on Technology Assessment in Health Care, 1993.Google Scholar
35.Goodwin, J. S., & Goodwin, J. M.The tomato effect: Rejection of highly efficacious therapies. JAMA, 1984, 251, 2387–90.CrossRefGoogle ScholarPubMed
36.Granados, A., Henshall, C., Banta, H. D., et al. EUR-ASSESS Project Subgroup report on priority setting for health technology assessment: Theoretical considerations and practical approaches. International Journal of Technology Assessment in Health Care, 1997,13, 144–85.Google Scholar
37.Granados, A., Jonsson, E., Banta, H. D., et al. EUR-ASSESS Subgroup report on dissemination and impact. International Journal of Technology Assessment in Health Care, 1997, 13, 220–85.CrossRefGoogle ScholarPubMed
38.Greer, A. L.The state of the art versus the state of the science: The diffusion of new medical technologies into practice. International Journal of Technology Assessment in Health Care, 1988, 4, 5–26.CrossRefGoogle ScholarPubMed
39.Hahn, R. A.The state of federal health statistics on racial and ethnic groups. JAMA, 1992, 267, 268–71.CrossRefGoogle ScholarPubMed
40.Halevy, A., & Brody, B., for the Houston City-wide Task Force on Medical Futility. A multi-institution policy on medical futility. JAMA, 1996, 275, 571–74.CrossRefGoogle Scholar
41.Hanes, P.Oregon Consumer Scorecard Project: Final report. Bethesda, MD: Agency for Health Care Policy and Research, 1997.Google Scholar
42.Hauerwas, S.Suffering presence: Theological reflections on medicine, the mentally ha capped, and the church. Notre Dame, IN: University of Notre Dame Press, 1986.Google Scholar
43.Heitman, E.Cultural diversity and the clinical encounter: Intercultural dialogue in multi ethnic patient care. In Mckenny, G. P. & Sande, J. (eds.), Theological analyses of the clinic encounter. Amsterdam, The Netherlands: Klewer Academic Publishers, 1994, 202–22.Google Scholar
44.Heitman, E., & Schlactenhaufen, M.The differential effects of race, ethnicity, and socioeconomic status on infertility and its treatment: Ethical and policy issues for oocyte donation. In Cohen, C. B. (ed.), New ways of making babies. Bloomington, IN: Indiana University Press, 1996,188–212.Google Scholar
45.Hellman, S., & Hellman, D. S.Of mice but not men: Problems of the randomized controlled trial. New England Journal of Medicine, 1991, 324, 1585–89.CrossRefGoogle ScholarPubMed
46.Hilts, P. I. House told of more tests done without consent. New York Times, 1994, 05 24, A13.Google Scholar
47.Huth, E. J.Irresponsible authorship and wasteful publication. Annals of Internal Medicine, 1986, 104, 257–59.CrossRefGoogle ScholarPubMed
48. In re Baby K, 832 F Supp 1022 (ED Va 1993) and 16 F3d 590 (4th Cir 1994).Google Scholar
49. In re Helga Wanglie, 4th Judicial District (District Court, Probate Court Div.) PX-91 283. Hennepin County, Minnesota.Google Scholar
50.Jonsen, A. R., & Toulmin, S. E.The abuse of casuistry: A history of moral reasoning. Berkeley, CA: University of California Press, 1988.Google Scholar
51.Kant, I., Groundwork of the metaphysic of morals. Paton, H. J. (trans.). New York: Harper Torch Books, 1964, 96.Google Scholar
52.Kassirer, J. P.Our stubborn quest for diagnostic certainty: A cause of excessive testing. New England Journal of Medicine, 1989, 320, 1489–91.CrossRefGoogle ScholarPubMed
53.Knox, E. G.Confidential medical records and epidemiological research. British Medical Journal, 304, 727–28.CrossRefGoogle Scholar
54.Koczwara, B. M., & Madigan, T. J.The heterogeneity of clinical ethics: The state of the field as reflected in the ‘Encyclopedia of Bioethics.’ Journal of Medicine and Philosophy, 1997, 22, 75–88.CrossRefGoogle Scholar
55.Kolata, G. Patients' lawyers lead insurers to pay for unproven treatments: Coverage even when policy excludes a therapy. New York Times, 1994, 03 28, A1, A7.Google Scholar
56.Levi, J.Unproven AIDS therapies: The Food and Drug Administration and ddl. In Hanna, K. E. (ed.), Biomedical politics. Washington, DC: National Academy Press, 1991, 9–37.Google Scholar
57.Liberati, A., Sheldon, T., Banta, H. D., et al. EUR-ASSESS Project Subgroup report on methodology: Methodological guidance for the conduct of health technology assessment. International Journal of Technology Assessment in Health Care, 1997, 13, 186–219.CrossRefGoogle ScholarPubMed
58.Malinoski, M. J.Capitation, advances in medical technology, and the advent of a new era in medical ethics. American Journal of Law and Medicine, 1996, 22, 331–60.CrossRefGoogle Scholar
59.Mant, D., & Fowler, G.Mass screening: Theory and ethics. British Medical Journal, 1990, 300, 916–18.CrossRefGoogle ScholarPubMed
60.Mastroianni, A. C., Faden, R., & Federman, D.Women and health research: Ethical and legal issues of including women in clinical studies. Washington, DC: National Academy Press, 1994.Google Scholar
61.McCullough, L. B.The management of instability and incompleteness: Clinical ethics and abstract expressionism. Journal of Medicine and Philosophy, 1997, 22, 1–10.CrossRefGoogle ScholarPubMed
62.McKinlay, J. B.From ‘promising report’ to ‘standard procedure’: Seven stages in the career of a medical innovation. Milbank Memorial Fund Quarterly, 1981, 59, 374–411.CrossRefGoogle ScholarPubMed
63.Musschenga, A. W.The relation between concepts of quality-of-life, health and happiness. Journal of Medicine and Philosophy, 1997, 22, 11–28.CrossRefGoogle ScholarPubMed
64.Nelkin, D.The social power of genetic information. In Kelves, D. J. & Hood, L. (eds.), The code of codes: Scientific and social issues in the Human Genome Project. Cambridge MA: Harvard University Press, 1992, 177–90.Google Scholar
65.Nelkin, D.The selling of science. New York: W. H. Freeman & Co., 1987, 170–82.Google Scholar
66.Neuhauser, D.Sharing research data. Medical Care, 1986, 24, 879–80.CrossRefGoogle ScholarPubMed
67.Noddings, N.Caring: A feminine approach to ethics in moral education. Los Angeles, CA: University of California Press, 1984.Google Scholar
68.The Nuremberg Code. In Trials of war criminals before the Nuernberg military tribunals under Control Council Law No. 10, vol. 2. Washington, DC: U.S. Government Printing Office, 1949, 181–82.Google Scholar
69.Passamani, E.Clinical trials: Are they ethical? New England Journal of Medicine, 1991, 324, 1585–92.CrossRefGoogle ScholarPubMed
70.Perry, S., Gardner, E., & Thamer, M.The status of health technology assessment worldwide: Results of an international survey. International Journal of Technology Assessment of Health Care, 1997, 13, 81–94.CrossRefGoogle ScholarPubMed
71.Ray, W. A., Griffin, M. R., & Avorn, J.Evaluating drugs after their approval for clinical use. New England Journal of Medicine, 1993, 329, 2029–32.CrossRefGoogle ScholarPubMed
72.Reiser, S. J.Medicine and the reign of technology. Cambridge, MA: MIT Press, 1978.Google Scholar
73.Relman, A. S.Financial incentives in clinical investigation. New England Journal of Medicine, 1989, 320, 933–34.CrossRefGoogle ScholarPubMed
74.Sheldon, T. A., & Parker, H.Race and ethnicity in health research. Journal of Public Health Medicine, 1992, 14, 104–10.Google ScholarPubMed
75.Sibbald, W. J., & Inman, K. J.Problems in assessing the technology of critical care medicine. International Journal of Technology Assessment in Health Care, 1992, 8, 419–43.CrossRefGoogle ScholarPubMed
76.Simpson, K. N., & Snyder, L. B.Informing the mammography coverage debate: Results of meta-analysis, computer modeling, and issue analysis. International Journal of Technology Assessment in Health Care, 1991, 7, 616–31.CrossRefGoogle ScholarPubMed
77.Skrabanek, P.Mass mammography: The time for reappraisal. International Journal of Technology Assessment in Health Care, 1989, 5, 423–30.CrossRefGoogle ScholarPubMed
78.Sontag, S.Illness as metaphor. New York: Strauss and Giroux, 1978.Google Scholar
79.Steffen, G. E.Quality medical care: A definition. JAMA, 1988, 260, 56–61.CrossRefGoogle ScholarPubMed
80.Tymstra, T.The imperative character of medical technology and the meaning of ‘anticipated decision regret.’ International Journal of Technology Assessment in Health Care, 1989, 5, 207–13.CrossRefGoogle ScholarPubMed
81.Tyson, J., & Kennedy, K. A.Are small randomized controlled trials unethical? Research ethics in an age of meta-analysis. Pediatric Research, 1994, 6, 47a.Google Scholar
82.U.S. Advisory Committee on Human Radiation Experiments. Final report. Washington, DC: U.S. Government Printing Office, 1995.Google Scholar
83.U.S. Congress, Office of Technology Assessment. Protecting privacy in computerized medical information. Washington, DC: U.S. Government Printing Office, 1994.Google Scholar
84.U.S. Department of Health and Human Services, Food and Drug Administration. Protection of human subjects: Informed consent. Federal Register, 1996, 61 (192), 51498–533.Google Scholar
85.Weiss, R., & Thier, S. O.HIV testing is the answer: What's the question? New England Journal of Medicine, 1988, 328, 1010–12.CrossRefGoogle Scholar
86.World Medical Association. Declaration of Helsinki: Recommendations guiding medical doctors in biomedical research involving human subjects, 4th ed.Geneva, Switzerland: WMA, 1989.Google Scholar
87.Zola, I. K.Pathways to the doctor: From person to patient. Social Science and Medicine, 1973, 7, 677–89.CrossRefGoogle Scholar
88.Zola, I. K.Medicine as an institution of social control. Sociological Review, 1972, 20, 487–504.CrossRefGoogle ScholarPubMed