Saarni Samuli I, Hofmann Bjørn, Lampe Kristian, Lühmann Dagmar, Mäkelä Marjukka, Velasco-Garrido Marcial, Autti-Rämö Ilona
Finnish Office for Health Technology Assessment, National Research and Development Centre for Welfare and Health, Helsinki, Finland.
Bull World Health Organ. 2008 Aug;86(8):617-23. doi: 10.2471/blt.08.051078.
Health technology assessment (HTA) is the multidisciplinary study of the implications of the development, diffusion and use of health technologies. It supports health-policy decisions by providing a joint knowledge base for decision-makers. To increase its policy relevance, HTA tries to extend beyond effectiveness and costs to also considering the social, organizational and ethical implications of technologies. However, a commonly accepted method for analysing the ethical aspects of health technologies is lacking. This paper describes a model for ethical analysis of health technology that is easy and flexible to use in different organizational settings and cultures. The model is part of the EUnetHTA project, which focuses on the transferability of HTAs between countries. The EUnetHTA ethics model is based on the insight that the whole HTA process is value laden. It is not sufficient to only analyse the ethical consequences of a technology, but also the ethical issues of the whole HTA process must be considered. Selection of assessment topics, methods and outcomes is essentially a value-laden decision. Health technologies may challenge moral or cultural values and beliefs, and their implementation may also have significant impact on people other than the patient. These are essential considerations for health policy. The ethics model is structured around key ethical questions rather than philosophical theories, to be applicable to different cultures and usable by non-philosophers. Integrating ethical considerations into HTA can improve the relevance of technology assessments for health care and health policy in both developed and developing countries.
卫生技术评估（HTA）是对卫生技术的开发、传播和使用所产生影响的多学科研究。它通过为决策者提供联合知识库来支持卫生政策决策。为提高其与政策的相关性，HTA试图超越有效性和成本，还考虑技术的社会、组织和伦理影响。然而，目前缺乏一种普遍接受的分析卫生技术伦理方面的方法。本文描述了一种卫生技术伦理分析模型，该模型在不同组织环境和文化中易于使用且灵活。该模型是欧盟卫生技术评估网络（EUnetHTA）项目的一部分，该项目专注于各国之间卫生技术评估的可转移性。EUnetHTA伦理模型基于这样一种见解，即整个HTA过程都充满了价值。仅分析技术的伦理后果是不够的，还必须考虑整个HTA过程的伦理问题。评估主题、方法和结果的选择本质上是一个充满价值的决策。卫生技术可能会挑战道德或文化价值观和信仰，其实施也可能对患者以外的人产生重大影响。这些是卫生政策的重要考虑因素。伦理模型围绕关键伦理问题而非哲学理论构建，以适用于不同文化并可供非哲学家使用。将伦理考量纳入HTA可以提高技术评估对发达国家和发展中国家医疗保健及卫生政策的相关性。
