title: HEALTH TECHNOLOGY ASSESSMENT, DELIBERATIVE PROCESS, AND ETHICALLY CONTESTED ISSUES.
abstract: Healthcare technology assessment (HTA) aims to support decisions as to which technologies should be used in which situations to optimize value. Because such decisions will create winners and losers, they are bound to be controversial. HTA, then, faces a dilemma: should it stay away from such controversies, remaining a source of incomplete advice and risking an important kind of marginalization, or should it enter the controversy? The question is a challenging one, because we lack agreement on principles that are fine grained enough to tell us what choices we should make. In this study, we will argue that HTA should take a stand on ethical issues raised by the technology that is being investigated. To do so, we propose adding a form of procedural justice to HTA to arrive at decisions that the public can regard as legitimate and fair. A fair process involves deliberation about the reasons, evidence, and rationales that are considered relevant to meeting population-health needs fairly. One important way to make sure that there is real deliberation about relevant reasons is to include a range of stakeholders in the deliberative process. To illustrate how such deliberation might work, we use the case of cochlear implants for deaf children.
authors.affiliation: Harvard School of Public Health,Department of Global Health and Populationndaniels@hsph.harvard.edu.
authors.forename: Norman
authors.initials: N
authors.lastname: Daniels
authors.affiliation: Donders Institute for Brain, Cognition, and Behavior,Radboud University Medical Centre.
authors.forename: Gert Jan
authors.initials: GJ
authors.lastname: van der Wilt
mesh_terms: D002648:Child; D003054:Cochlear Implants / Q000191:economics / Q000941:ethics; D057186:Comparative Effectiveness Research / Q000458:organization & administration; D003362:Cost-Benefit Analysis; D019988:Children with Disabilities / Q000534:rehabilitation; D015276:Health Care Rationing / Q000941:ethics / Q000458:organization & administration; D006291:Health Policy; D006292:Health Priorities / Q000458:organization & administration; D006801:Humans; D018803:Models, Economic; D019986:Persons with Hearing Disabilities / Q000534:rehabilitation; D011050:Policy Making; D012107:Research Design; D012935:Social Justice; D013673:Technology Assessment, Biomedical / Q000941:ethics* / Q000458:organization & administration*
keywords: Accountability; Cochlear implants; Deliberative democracy; Fairness; Priority setting; Wide reflective equilibrium