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Integration of ethical considerations into HTA reports: an analysis of integration levels using a systematic review

Published online by Cambridge University Press:  26 April 2021

Georges-Auguste Legault
Affiliation:
Faculté de Droit, Université de Sherbrooke, Sherbrooke, Quebec, Canada Institut Interdisciplinaire d'Innovation Technologique (3IT) de l'Université de Sherbrooke, Parc Innovation P2, 3000 Boul. de l'Université, Sherbrooke, QuebecJ1K 0A5, Canada
Hubert Gagnon
Affiliation:
Institut Interdisciplinaire d'Innovation Technologique (3IT) de l'Université de Sherbrooke, Parc Innovation P2, 3000 Boul. de l'Université, Sherbrooke, QuebecJ1K 0A5, Canada
Monelle Parent
Affiliation:
Institut Interdisciplinaire d'Innovation Technologique (3IT) de l'Université de Sherbrooke, Parc Innovation P2, 3000 Boul. de l'Université, Sherbrooke, QuebecJ1K 0A5, Canada
Christian A. Bellemare
Affiliation:
Institut Interdisciplinaire d'Innovation Technologique (3IT) de l'Université de Sherbrooke, Parc Innovation P2, 3000 Boul. de l'Université, Sherbrooke, QuebecJ1K 0A5, Canada Clinical Quality Division, Centre Intégré Universitaire de Santé et de Services Sociaux (CIUSSS) de l'Estrie – Centre Hospitalier de l'Université de Sherbrooke (CHUS), Sherbrooke, Quebec, Canada
Jean-Pierre Béland
Affiliation:
Institut Interdisciplinaire d'Innovation Technologique (3IT) de l'Université de Sherbrooke, Parc Innovation P2, 3000 Boul. de l'Université, Sherbrooke, QuebecJ1K 0A5, Canada Unité d'Enseignement en Éthique, Département des Sciences Humaines, Université du Québec à Chicoutimi (UQAC), Sherbrooke, Quebec, Canada
Suzanne Kocsis-Bédard
Affiliation:
Institut Interdisciplinaire d'Innovation Technologique (3IT) de l'Université de Sherbrooke, Parc Innovation P2, 3000 Boul. de l'Université, Sherbrooke, QuebecJ1K 0A5, Canada Centre Intégré Universitaire de Santé et de Services Sociaux (CIUSSS) de l'Estrie – Centre Hospitalier de l'Université de Sherbrooke (CHUS), Centre de Recherche Clinique du CHUS, Sherbrooke, Quebec, Canada
Louise Bernier
Affiliation:
Faculté de Droit, Université de Sherbrooke, Sherbrooke, Quebec, Canada Institut Interdisciplinaire d'Innovation Technologique (3IT) de l'Université de Sherbrooke, Parc Innovation P2, 3000 Boul. de l'Université, Sherbrooke, QuebecJ1K 0A5, Canada
Pierre Dagenais
Affiliation:
Institut Interdisciplinaire d'Innovation Technologique (3IT) de l'Université de Sherbrooke, Parc Innovation P2, 3000 Boul. de l'Université, Sherbrooke, QuebecJ1K 0A5, Canada Faculté de Médecine et des Sciences de la Santé de l'Université de Sherbrooke, Centre Intégré Universitaire de Santé et de Services Sociaux (CIUSSS) de l'Estrie – Centre Hospitalier de l'Université de Sherbrooke (CHUS), Centre de Recherche Clinique du CHUS, Sherbrooke, Quebec, Canada
Charles-Étienne Daniel
Affiliation:
Faculté de Droit, Université de Sherbrooke, Sherbrooke, Quebec, Canada Institut Interdisciplinaire d'Innovation Technologique (3IT) de l'Université de Sherbrooke, Parc Innovation P2, 3000 Boul. de l'Université, Sherbrooke, QuebecJ1K 0A5, Canada
Johane Patenaude*
Affiliation:
Institut Interdisciplinaire d'Innovation Technologique (3IT) de l'Université de Sherbrooke, Parc Innovation P2, 3000 Boul. de l'Université, Sherbrooke, QuebecJ1K 0A5, Canada Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Quebec, Canada
*
Author for correspondence: Johane Patenaude, E-mail: johane.patenaude@usherbrooke.ca

Abstract

Objective

To describe the type and level of ethical integration in published health technology assessment (HTA) reports and systematically identify the ethical approaches utilized.

Methods

A literature search was conducted with the Google™ search engine using the keyword “ethic” between 1 January 2015 and 20 August 2019. Only HTA assessment reports with a section on ethics were retained and classified according to their level of ethical integration: no ethical analysis, ethical issues highlighted, assessments according to legal or social norms, and assessments from a moral or axiological perspective—using a qualitative methodology to distinguish such integration.

Results

This review yielded 188 reports with a section identified as being on ethics, produced by seventeen HTA agencies in eleven countries. One hundred and thirty-six reports did not develop an ethical analysis, thirty-one highlighted ethical issues, seventeen conducted a norm-based ethical assessment using a descriptive approach grounded in social norms, and four developed an assessment grounded in a moral or axiological perspective. The bioethical “four-principles” framework was used, but mainly for presenting ethical issues and not as a moral framework.

Conclusions

The majority of reports featuring a section on ethics mention ethical considerations without ethical analysis. Ethical issues are grouped with legal, social, and organizational issues and treated as contextual considerations that decision makers should be aware of. When reports present systematic norm-based ethical assessments from a descriptive perspective or ethical assessment based on a moral or axiological perspective, there is a tendency to ground these analyses in frameworks created for the purpose and reliant on a concept of ethics supporting them.

Type
Method
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

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