title: Current state of ethics literature synthesis: a systematic review of reviews.
abstract: BACKGROUND
  Modern standards for evidence-based decision making in clinical care and public health still rely solely on eminence-based input when it comes to normative ethical considerations. Manuals for clinical guideline development or health technology assessment (HTA) do not explain how to search, analyze, and synthesize relevant normative information in a systematic and transparent manner. In the scientific literature, however, systematic or semi-systematic reviews of ethics literature already exist, and scholarly debate on their opportunities and limitations has recently bloomed.
  
  
  METHODS
  A systematic review was performed of all existing systematic or semi-systematic reviews for normative ethics literature on medical topics. The study further assessed how these reviews report on their methods for search, selection, analysis, and synthesis of ethics literature.
  
  
  RESULTS
  We identified 84 reviews published between 1997 and 2015 in 65 different journals and demonstrated an increasing publication rate for this type of review. While most reviews reported on different aspects of search and selection methods, reporting was much less explicit for aspects of analysis and synthesis methods: 31 % did not fulfill any criteria related to the reporting of analysis methods; for example, only 25 % of the reviews reported the ethical approach needed to analyze and synthesize normative information.
  
  
  CONCLUSIONS
  While reviews of ethics literature are increasingly published, their reporting quality for analysis and synthesis of normative information should be improved. Guiding questions are: What was the applied ethical approach and technical procedure for identifying and extracting the relevant normative information units? What method and procedure was employed for synthesizing normative information? Experts and stakeholders from bioethics, HTA, guideline development, health care professionals, and patient organizations should work together to further develop this area of evidence-based health care.
authors.affiliation: Institute of History, Ethics and Philosophy of Medicine, Hannover Medical School, Hannover, Germany.|Research Unit Ethics, Institute of History and Ethics of Medicine, University Hospital Cologne, Cologne, Germany.
authors.forename: Marcel
authors.initials: M
authors.lastname: Mertz
authors.affiliation: Institute of History, Ethics and Philosophy of Medicine, Hannover Medical School, Hannover, Germany.
authors.forename: Hannes
authors.initials: H
authors.lastname: Kahrass
authors.affiliation: Institute of History, Ethics and Philosophy of Medicine, Hannover Medical School, Hannover, Germany. strech.daniel@mh-hannover.de.
authors.forename: Daniel
authors.initials: D
authors.lastname: Strech
mesh_terms: D002983:Clinical Competence; D003657:Decision Making / Q000941:ethics*; D026690:Ethics, Clinical; D019317:Evidence-Based Medicine / Q000941:ethics*; D006801:Humans; D009014:Morals; D011634:Public Health; D011640:Public Policy; D013673:Technology Assessment, Biomedical / Q000941:ethics*
keywords: Argument-based literature; Bioethics; Empirical ethics; Evidence-based medicine; Literature review; Literature search; Normative literature; Systematic review