title: Integrating ethics in health technology assessment: many ways to Rome.
abstract: OBJECTIVE
  The aim of this study was to identify and discuss appropriate approaches to integrate ethical inquiry in health technology assessment (HTA).
  
  
  METHODS
  The key question is how ethics can be integrated in HTA. This is addressed in two steps: by investigating what it means to integrate ethics in HTA, and by assessing how suitable the various methods in ethics are to be integrated in HTA according to these meanings of integration.
  
  
  RESULTS
  In the first step, we found that integrating ethics can mean that ethics is (a) subsumed under or (b) combined with other parts of the HTA process; that it can be (c) coordinated with other parts; or that (d) ethics actively interacts and changes other parts of the HTA process. For the second step, we found that the various methods in ethics have different merits with respect to the four conceptions of integration in HTA.
  
  
  CONCLUSIONS
  Traditional approaches in moral philosophy tend to be most suited to be subsumed or combined, while processual approaches being close to the HTA or implementation process appear to be most suited to coordinated and interactive types of integration. The article provides a guide for choosing the ethics approach that appears most appropriate for the goals and process of a particular HTA.
authors.affiliation: Centre for Medical Ethics,University of Oslo and University College of Gjøvikb.m.hofmann@medisin.uio.no.
authors.forename: Björn
authors.initials: B
authors.lastname: Hofmann
authors.affiliation: ECORYS Netherlands BV.
authors.forename: Wija
authors.initials: W
authors.lastname: Oortwijn
authors.affiliation: Centre for Medical Ethics,University of Oslo.
authors.forename: Kristin
authors.initials: K
authors.lastname: Bakke Lysdahl
authors.affiliation: Institute of Bioethics,"A. Gemelli" School of Medicine,Università Cattolica del Sacro Cuore,Rome,Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Refolo
authors.affiliation: Institute of Bioethics,"A. Gemelli" School of Medicine,Università Cattolica del Sacro Cuore,Rome,Italy.
authors.forename: Dario
authors.initials: D
authors.lastname: Sacchini
authors.affiliation: Radboud University Medical Centre,Institute for Health Sciences,Nijmegen,the Netherlands.
authors.forename: Gert Jan
authors.initials: GJ
authors.lastname: van der Wilt
authors.affiliation: Institute of Public Health and Nursing Research,University of Bremen,Germany.
authors.forename: Ansgar
authors.initials: A
authors.lastname: Gerhardus
mesh_terms: D026689:Ethical Analysis; D006801:Humans; D007558:Italy; D009014:Morals; D010686:Philosophy, Medical; D013673:Technology Assessment, Biomedical / Q000941:ethics* / Q000458:organization & administration*
keywords: Ethics; Health Technology Assessment; Morals; Norms; Values