The ethics of assessing health technologies

Health technology assessment (HTA) consists of the systematic study of the consequences of the introduction or continued use of the technology in a particular context, with the explicit objective to arrive at a judgment of the value or merit of the technology. Ideally, it is aimed at assessing all aspects of a given technology or group of technologies, including non-technical, e.g. socio-ethical, aspects. However, methods for assessing socio-ethical implications of health technology are relatively undeveloped and few mechanisms exist to take action based on the results of such evaluations. Still, the examples of cochlear inplants (CI) and other cases illustrate that HTA is not a matter of merely collecting the facts about a technology. The facts must be plausible and relevant from a particular framework, which is not always shared by different groups. It is here that socio-ethical aspects are encountered. If health technology assessment aims to enhance the accountability of the decision making process regarding funding and use of health technology, it is a major challenge to assessors of health technologies to deal adequately with existing value pluralism. In this respect interactive evaluation may have something to offer.