title: Different methods for ethical analysis in health technology assessment: an empirical study.
abstract: OBJECTIVE
  Ethical analysis can highlight important ethical issues related to implementing a technology, values inherent in the technology itself, and value-decisions underlying the health technology assessment (HTA) process. Ethical analysis is a well-acknowledged part of HTA, yet seldom included in practice. One reason for this is lack of knowledge about the properties and differences between the methods available. This study compares different methods for ethical analysis within HTA.
  
  
  METHODS
  Ethical issues related to bariatric (obesity) surgery were independently evaluated using axiological, casuist, principlist, and EUnetHTA models for ethical analysis within HTA. The methods and results are presented and compared.
  
  
  RESULTS
  Despite varying theoretical underpinnings and practical approaches, the four methods identified similar themes: personal responsibility, self-infliction, discrimination, justice, public funding, and stakeholder involvement. The axiological and EUnetHTA models identified a wider range of arguments, whereas casuistry and principlism concentrated more on analyzing a narrower set of arguments deemed more important.
  
  
  CONCLUSIONS
  Different methods can be successfully used for conducting ethical analysis within HTA. Although our study does not show that different methods in ethics always produce similar results, it supports the view that different methods of ethics can yield relevantly similar results. This suggests that the key conclusions of ethical analyses within HTA can be transferable between methods and countries. The systematic and transparent use of some method of ethics appears more important than the choice of the exact method.
authors: National Institute for Health and Welfare, Department of Mental Health and Finnish Office for Health Technology Assessment, PO Box 30, 00271 Helsinki, Finland. Samuli.saarni@helsinki.fi
authors: Samuli I
authors: SI
authors: Saarni
authors: Annette
authors: A
authors: Braunack-Mayer
authors: Bjørn
authors: B
authors: Hofmann
authors: Gert Jan
authors: GJ
authors: van der Wilt
mesh_terms: D050110:Bariatric Surgery / Q000191:economics* / Q000941:ethics*; D032764:Casuistry; D026689:Ethical Analysis; D005380:Financing, Government; D006801:Humans; D009014:Morals; D013673:Technology Assessment, Biomedical / Q000458:organization & administration*