HTA Ethical domain as health care support for decision making: state-of-the-art and perspectives

Objectives: Health Technology Assessment (HTA) is a multidisciplinary process that collect information about medical/economic/organizational/ethical/legal/social issues related to the use of an health technology (HT) in a systematic/transparent/unbiased manner. Its purpose is to support health care decision-makers. From the conception of HTA in the 1970s, it has been argued that the ethical (ETH) domain is a constitutive part of HTA and that value judgments are inherent in the whole HTA process. This contribution is aimed at discussing methodologies, issues and experiences in HTA-ETH domain. Methods: Research query on Pubmed and manual web retrieval on international/national HTA bodies was carried out. Results: HTA-ETH domain aims at analyzing both the ethical questions that a given technology raises when it is put into use/disinvestment as well as ethical issues that the HTA process itself raises. Even though ETH domain is a constitutive part of HTA, ethics has not so frequently been part of HTA reports. Reasons for that are analyzed. Available HTA ethical analyses are worded as an assessment, a list of ethical issues, and/or an appraisal, a moral judgement regarding an HT. A wide range of (up to 43) approaches have been suggested to address HTA-ETH domain. Two further questions are open: standard operative procedures for HTA-ETH domain quality check and the definition of specific core competencies for experts involved. Finally, the experience in HTA-ETH domain of Institute of Bioethics & Medical Humanities (IBioMedH) of Università Cattolica del Sacro Cuore (UCSC), Fondazione Policlinico Universitario “Agostino Gemelli” (FPG), Rome (Italy), from 2005 up to now is showed. Conclusion: HTA-ETH domain is a further expanding field for carrying out healthcare ethical expertise/consultation.