Abstract
This chapter presents and analyses six ethical rationales for patient involvement in HTA. We have identified three instrumental and three substantive rationales, namely, (1) relevance to healthcare goals and healthcare needs, (2) legitimacy leading to adherence to decisions, (3) capacity building via patient empowerment, (4) fairness and legitimacy through democratic participation, (5) fairness through respect for autonomy and (6) equity. Our ethical analysis finds that these rationales support patient involvement in HTA under specific premises. For example, relevance to healthcare goals and needs mainly support the use of patient-based evidence, while the other rationales require patient participation in some form. That is, for HTA to be legitimate enough to increase adherence, patients probably need to participate in the process and the same goes for equity. Likewise, when the rationales are democratic participation, empowerment and autonomy. Importantly, in order to achieve strong ethical support for patient involvement in HTA, it is crucial to ensure that these premises and their preconditions are fulfilled. On the other hand, all rationales raise issues of representation, i.e. which patient group should be represented through evidence or participation.
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References
Bridges JFP, Jones C. Patient-based health technology assessment: a vision of the future. Int J Technol Assess Health Care. 2007;23:30–5.
Brostrom L, Johansson M, Nielsen MK. “What the patient would have decided”: a fundamental problem with the substituted judgment standard. Med Health Care Philos. 2007;10:265–78. doi:10.1007/s11019-006-9042-2.
Coulter A. Perspectives on health technology assessment: response from the patient's perspective. Int J Technol Assess Health Care. 2004;20:92–6.
Entwistle VA, Watt IS. Treating patients as persons: a capabilities approach to support delivery of person-centered care. Am J Bioeth. 2013;13:29–39. doi:10.1080/15265161.2013.802060.
Facey K, Boivin A, Gracia J, Hansen HP, Lo Scalzo A, Mossman J, et al. Patients’ perspectives in health technology assessment: a route to robust evidence and fair deliberation. Int J Technol Assess Health Care. 2010;26:334–40. doi:10.1017/s0266462310000395.
Fishkin JS, Luskin RC. Experimenting with a democratic ideal: deliberative polling and public opinion. Acta Polit. 2005;40:284–98. doi:10.1057/palgrave.ap.5500121.
Gagnon MP, Desmartis M, Gagnon J, St-Pierre M, Rhainds M, Coulombe M, et al. Framework for user involvement in health technology assessment at the locale level: views of health managers, user representatives and clinicians. Int J Technol Assess Health Care. 2015;31:68–77. doi:10.1017/s0266462315000070.
Gauvin F-P, Abelson J, Giacomini M, Eyles J, Lavis JN. “it all depends”: conceptualizing public involvement in the context of health technology assessment agencies. Soc Sci Med. 2010;70:1518–26. doi:10.1016/j.socscimed.2010.01.036.
Gustavsson E, Sandman L. Health-care needs and shared decision-making in priority setting. Med Health Care Philos. 2014;18(1):13–22.
Habermas J. The theory of communicative action. Boston: Beacon Press; 1984.
Hofmann B. Priority setting in health care: trends and models from Scandinavian experiences. Med Health Care Philos. 2013;16:349–56. doi:10.1007/s11019-012-9414-8.
Hofmann BM. Why ethics should be part of health technology assessment. Int J Technol Assess Health Care. 2008;24:423–9. doi:10.1017/s0266462308080550.
IAP2. Public participation spectrum. 2015. https://www.iap2.org.au/documents/item/83.
Kim SYH, Wall IF, Stanczyk A, De Vries R. Assessing the public’s views in research ethics controversies: deliberative democracy and bioethics as natural allies. J Empir Res Hum Res Ethics. 2009;4:3–16. doi:10.1525/jer.2009.4.4.3.
Kreis J, Schmidt H. Public engagement in health technology assessment and coverage decisions: a study of experiences in France, Germany, and the United Kingdom. J Health Polit Policy Law. 2013;38:89–122. doi:10.1215/03616878-1898812.
Milewa T. Representation and legitimacy in health policy formulation at a national level: perspectives from a study of health technology eligibility procedures in the United Kingdom. Health Policy. 2008;85:356–62. doi:10.1016/j.healthpol.2007.09.001.
Munthe C, Sandman L, Cutas D. Person centred care and shared decision making: implications for ethics, public health and research. Health Care Anal. 2012;20:231–49. doi:10.1007/s10728-011-0183-y.
Nordenfelt L. The concept of work ability. P.I.E. Peter Lang: Bruxelles, New York; 2008.
OHTAC Public Engagement Subcommittee. Public engagement for health technology assessment at health quality Ontario–final report from the Ontario health technology advisory committee public subcommittee [internet]. Toronto: Queen’s Printer for Ontario; 2015. http://www.hqontario.ca/Portals/0/documents/evidence/special-reports/report-subcommittee-20150407-en.pdf Accessed 27 Aug 2016
Ryfe DM. Does deliberative democracy work? Ann Rev Pol Sci. 2005;8:49–71.
Saarni S, Autti-Rämö I, Lühman D, Hofmann B, Velasco-Garrido M, Lopez de Argumedo M et al. Ethical analysis. HTA core model for medical and surgical interventions 2008. https://meka.thl.fi/htacore/model/HTA%20Core%20Model%20for%20Medical%20and%20Surgical%20Interventions%201.0r.pdf
Sandman L, Munthe C. Shared decision-making and patient autonomy. Theor Med Bioeth. 2009;30:289–310. doi:10.1007/s11017-009-9114-4.
Sjostrand M, Eriksson S, Juth N, Helgesson G. Paternalism in the name of autonomy. J Med Philos. 2013;38:710–24. doi:10.1093/jmp/jht049.
Sjostrand M, Juth N. Authenticity and psychiatric disorder: does autonomy of personal preferences matter? Med Health Care Philos. 2014;17:115–22. doi:10.1007/s11019-013-9509-x.
Sunstein CR. Group polarization and 12 angry men. Negot J. 2007;23:443–7. doi:10.1111/j.1571-9979.2007.00155.x.
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Sandman, L., Bond, K., Hofmann, B. (2017). Exploring Ethical Rationales. In: Facey, K., Ploug Hansen, H., Single, A. (eds) Patient Involvement in Health Technology Assessment. Adis, Singapore. https://doi.org/10.1007/978-981-10-4068-9_2
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