title: Tackling ethical issues in health technology assessment: a proposed framework.
abstract: OBJECTIVE
  Values are intrinsic to the use of health technology assessments (HTAs) in health policy, but neglecting value assumptions in HTA makes their results appear more robust or normatively neutral than may be the case. Results of a 2003 survey by the International Network of Agencies for Health Technology Assessment (INAHTA) revealed the existence of disparate methods for making values and ethical issues explicit when conducting HTA.
  
  
  METHODS
  An Ethics Working Group, with representation from sixteen agencies, was established to develop a framework for addressing ethical issues in HTA. Using an iterative approach, with email exchanges and face-to-face workshops, a report on Handling Ethical Issues was produced.
  
  
  RESULTS
  This study describes the development process and the agreed upon framework for reflexive ethical analysis that aims to uncover and explore the ethical implications of technologies through an integrated, context-sensitive approach and situates the proposed framework within previous work in the development of ethics analysis in HTA.
  
  
  CONCLUSIONS
  It is important that methodological approaches to address ethical reflection in HTA be integrative and context sensitive. The question-based approach described and recommended here is meant to elicit this type of reflection in a way that can be used by HTA agencies. The questions proposed are considered only as a starting point for handling ethics issues, but their use would represent a significant improvement over much of the existing practice.
authors: University of Oxford and Oxfordshire Primary Care Trust. Amanda.Burls@phc.ox.ac.uk
authors: Amanda
authors: A
authors: Burls
authors: Lorraine
authors: L
authors: Caron
authors: Ghislaine
authors: G
authors: Cleret de Langavant
authors: Wybo
authors: W
authors: Dondorp
authors: Christa
authors: C
authors: Harstall
authors: Ela
authors: E
authors: Pathak-Sen
authors: Bjørn
authors: B
authors: Hofmann
mesh_terms: D004493:Education; D006126:Group Processes; D006801:Humans; D013673:Technology Assessment, Biomedical / Q000941:ethics*