Hofmann Bjørn, Bond Ken, Sandman Lars
Institute for the Health Sciences, Norwegian University of Science and Technology (NTNU), Gjøvik, Norway.
Centre of Medical Ethics, University of Oslo, Oslo, Norway.
J Eval Clin Pract. 2018 Oct;24(5):957-965. doi: 10.1111/jep.12920. Epub 2018 Apr 3.
Health technology assessment (HTA) is an evaluation of health technologies in terms of facts and evidence. However, the relationship between facts and values is still not clear in HTA. This is problematic in an era of "fake facts" and "truth production." Accordingly, the objective of this study is to clarify the relationship between facts and values in HTA. We start with the perspectives of the traditional positivist account of "evaluating facts" and the social-constructivist account of "facting values." Our analysis reveals diverse relationships between facts and a spectrum of values, ranging from basic human values, to the values of health professionals, and values of and in HTA, as well as for decision making. We argue for sensitivity to the relationship between facts and values on all levels of HTA, for being open and transparent about the values guiding the production of facts, and for a primacy for the values close to the principal goals of health care, ie, relieving suffering. We maintain that philosophy (in particular ethics) may have an important role in addressing the relationship between facts and values in HTA. Philosophy may help us to avoid fallacies of inferring values from facts; to disentangle the normative assumptions in the production or presentation of facts and to tease out implicit value judgements in HTA; to analyse evaluative argumentation relating to facts about technologies; to address conceptual issues of normative importance; and to promote reflection on HTA's own value system. In this we argue for a(n Aristotelian) middle way between the traditional positivist account of "evaluating facts" and the social-constructivist account of "facting values," which we call "factuation." We conclude that HTA is unique in bringing together facts and values and that being conscious and explicit about this "factuation" is key to making HTA valuable to both individual decision makers and society as a whole.
卫生技术评估（HTA）是基于事实和证据对卫生技术进行的评价。然而，在卫生技术评估中，事实与价值观之间的关系仍不明确。在一个存在“虚假事实”和“真相制造”的时代，这是个问题。因此，本研究的目的是阐明卫生技术评估中事实与价值观之间的关系。我们从传统实证主义对“评估事实”的观点以及社会建构主义对“建构价值观”的观点入手。我们的分析揭示了事实与一系列价值观之间的多样关系，这些价值观包括基本人类价值观、卫生专业人员的价值观、卫生技术评估中的价值观以及决策中的价值观。我们主张在卫生技术评估的各个层面都要对事实与价值观之间的关系保持敏感，要对指导事实产生的价值观保持开放和透明，并且要重视与医疗保健主要目标相近的价值观，即减轻痛苦。我们认为哲学（尤其是伦理学）在解决卫生技术评估中事实与价值观的关系方面可能发挥重要作用。哲学可以帮助我们避免从事实推断价值观的谬误；理清事实产生或呈现过程中的规范性假设，并梳理出卫生技术评估中隐含的价值判断；分析与技术事实相关的评价性论证；解决具有规范重要性的概念问题；以及促进对卫生技术评估自身价值体系的反思。在此，我们主张在传统实证主义对“评估事实”的观点与社会建构主义对“建构价值观”的观点之间走一条（亚里士多德式的）中间道路，我们称之为“事实建构”。我们得出结论，卫生技术评估在将事实与价值观结合在一起方面是独特的，并且意识到并明确这种“事实建构”是使卫生技术评估对个体决策者和整个社会都有价值的关键。
