Skip to main content Accessibility help

Mapping the integration of social and ethical issues in health technology assessment

  • Pascale Lehoux (a1) and Bryn Williams-Jones (a1)

Background: Since its inception, the field of health technology assessment (HTA) has stressed the need for consideration of ethical and social issues. However, few concepts or analytic tools have been developed, and because of the complexity of the endeavor and a lack of integration of work already produced, such concepts remain difficult to apply in HTA.

Objectives: Through a descriptive “map” of concepts, tools, and processes, we summarize the most tangible efforts on the part of HTA producers to address social and ethical issues.

Methods: A literature review and content analysis of HTA reports in the Centre for Reviews and Dissemination database enables a synthesis of the reflections on, initiatives around, and gaps in knowledge related to the integration of social and ethical issues in HTA.

Results: We examine: (i) the aim of integrating ethical and social issues in HTA, (ii) the theoretical approaches used, (iii) the methods and processes applied, and (iv) the implications for HTA producers. We highlight two levels at which social and ethical issues can be considered: throughout the production process of HTA reports and as part of the organizational structure of HTA agencies.

Conclusions: Given the profound societal changes that occur in relation to healthcare technology development, HTA producers have a responsibility to inform and enlighten technology-related public and policy debates. Fulfilling this role, though, requires that socioethical dimensions of technology and HTA are made explicit.

Corresponding author
P. Lehoux, a scholar of health administration and HTA, holds a Canada Research Chair on Innovations in Health (2005-10); two sections of this study partly draw from her book The Problem of Health Technology. Policy Implications for Modern Health Care Systems.
Williams-Jones, a bioethics scholar working on ethics, technology, and health care, was supported by grants from the Canadian Institutes of Health Research and the Faculty of Medicine, University of Montreal.
Hide All
Abelson J, Forest P-G, Eyles J, et al. 2003 Deliberations about deliberative methods: Issues in the design and evaluation of public participation processes. Soc Sci Med. 57: 239251.
Anderson Garcia S. 1996 Sociocultural and legal implications of creating and sustaining life through biomedical technology. J Legal Med. 17: 469525.
Banta D. 1997 Perry S. A history of ISTAHC: A personal perspective on its first 10 years. Int J Technol Assess Health Care. 13: 430453.
Burgess MM. 2003 Public consultation in ethics: An experiment in representative ethics. J Bioeth Inq. 1: 413.
Cleret de Langavant G. 2000 Method and complexity in bioethics: The example of community genetics. Community Genet. 3: 141143.
De Vries R. 2002 How can we help? From “sociology in” to “sociology of” bioethics. J Law Med Ethics. 32: 27992.
Dixon-Woods M, Agarwal S, Young B, Jones D, Sutton A. 2004. Integrative approaches to qualitative and quantitative evidence. London: National Health Service (NHS), Health Development Agency;
Droste S, Gerhardus A, Kollek R. 2003: Methods for integrating ethical aspects and social values in short HTA-reports. An international inventory. German Agency of Health Technology Assessment at German Institute for Medical Documentation and Information (DAHTA) (DIMDI); 9.
Gallo P. 2004 Integrating ethical enquiry and health technology assessment: Limits and opportunities for efficiency and equity. Poiesis Praxis. 2: 103117.
Giacomini M, Hurley J, Gold I, Smith P, Abelson J. 2004 The policy analysis of “values talk”: Lessons from Canadian health reform. Health Policy. 67: 1524.
Giacomini M, Miller F, Browman G. 2003 Confronting the “gray zones” of technology assessment: Evaluating genetic testing services for public insurance coverage in Canada. Int J Technol Assess Health Care. 19: 301316.
Grin J. 2004 Health technology assessment between our health care system and our health. Poiesis Praxis. 2: 157174.
Grunwald A. 2004 The normative basis of (health) technology assessment and the role of ethical expertise. Poiesis Praxis. 2: 175194.
Haimes E. 2002 What can the social sciences contribute to the study of ethics? Theoretical, empirical and substantive considerations. Bioethics. 16: 89113.
Hasman A. 2003 Eliciting reasons: Empirical methods in priority setting. Health Care Anal. 11: 4158.
Hofmann B. 2005 Toward a procedure for integrating moral issues in health technology assessment. Int J Technol Assess Health Care. 21: 312318.
Hoffmaster B. 1992 Can ethnography save the life of medical ethics. Soc Sci Med. 35: 14211431.
Heitman E. 1998 Ethical issues in technology assessment: Conceptual categories and procedural considerations. Int J Technol Assess Health Care. 14: 544566.
Heitman E. 1999 Social and ethical aspects of in vitro fertilization. Int J Technol Assess Health Care. 15: 2235.
Johri M, Lehoux P. 2003 The great escape? Health technology assessment as a means of cost control. Int J Technol Assess Health Care. 19: 179193.
Kenen RG. 1996 The at-risk health status and technology: A diagnostic invitation and the “gift” of knowing. Soc Sci Med. 42: 15451553.
Kmet L, Lee RC, Cook LS, et al. 2004. Alberta Heritage Foundation for Medical research (AHFMR). Systematic review of the social, ethical, and legal dimensions of genetic cancer risk assessment. AHFMR: Edmonton;
Lavis JN, Ross SE, Hurley JE, et al. 2002 Examining the role of health services research in public policy-making. Milbank Q. 80: 125154.
Lehoux P. 2006. The problem of health technology. Policy implications for modern health care systems. New York: Routledge;
Lehoux P, Blume S. 2000 Technology assessment and the sociopolitics of health technologies. J Health Polit Policy Law. 25: 10831120.
Lehoux P, Tailliez S, Denis J-L, Hivon M. 2004 Redefining HTA in Canada: Diversification of products and contextualization of findings. Int J Technol Assess Health Care. 20: 325336.
Leroux T, Hirtle M, Fortin L-N. 1998 An overview of public consultation mechanisms developed to address the ethical and social issues raised by biotechnology. J Consum Policy. 21: 445.
Moldrup C. 2002 Medical technology assessment of the ethical, social, and legal implications of pharmacogenomics. A research proposal for an Internet citizen jury. Int J Technol Assess Health Care. 18: 728732.
Molewijk AC, Stiggelbout AM, Otten W, Dupuis HM, Kievit J. 2004 Implicit normativity in evidence-based medicine: A plea for integrated empirical ethics research. Health Care Anal. 11: 6992.
Murphy E, Dingwall R, Greatbatch D, et al. 1998 Qualitative research methods in health technology assessment: A review of the literature. Health Technol Assess. 2: iiiix, 1-274.
National Institute for Clinical Excellence (NICE). Citizens Council Report on age. NICE: London; Undated.
National Institute for Clinical Excellence (NICE). 2005. Social value judgements. Principles for the development of NICE guidance. NICE: London;
Oortwijn W, Reuzel R, Decker M. 2004 Introduction. Poiesis Praxis. 2: 97102.
Reiter-Theil S. 2004 Does empirical research make bioethics more relevant? The “embedded researcher” as a methodological approach. Med Health Care Philos. 7: 1729.
Reuzel R, Oortwijn W, Decker M, et al. 2004 Ethics and HTA: Some lessons and challenges for the future. Poiesis Praxis. 2: 247256.
Royle J, Oliver S. 2004 Consumer involvement in the health technology assessment program. Int J Technol Assess Health Care. 20: 493497.
van der Wilt GJ. 2004 Health technology assessment: Trying to bring empirical and ethical inquiry together. Poiesis Praxis. 2: 195206.
ten Have H. 2004 Ethical perspectives on health technology assessment. Int J Technol Assess Health Care. 20: 7176.
Webster A. 2004 Health technology assessment: A sociological commentary on reflexive innovation. Int J Technol Assess Health Care. 20: 6166.
Williams T, May C, Mair F, Mort M, Gask L. 2003 Normative models of health technology assessment and the social production of evidence about telehealth care. Health Policy. 64: 3954.
Williams-Jones B, Burgess MM. 2004 Social contract theory and just decision making: Lessons from genetic testing for BRCA mutations. Kennedy Inst Ethics J. 14: 115142.
Williams-Jones B, Graham JE. 2003 Actor-network theory: A tool to support ethical analysis of commercial genetic testing. New Genet Soc. 22: 271296.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

International Journal of Technology Assessment in Health Care
  • ISSN: 0266-4623
  • EISSN: 1471-6348
  • URL: /core/journals/international-journal-of-technology-assessment-in-health-care
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed