This paper explores the usefulness of the 'ethical matrix', proposed by Ben Mepham, as a tool in technology assessment, specifically in food ethics. We consider what the matrix is, how it might be useful as a tool in ethical decision-making, and what drawbacks might be associated with it. We suggest that it is helpful for fact-finding in ethical debates relating to food ethics; but that it is much less helpful in terms of weighing the different (...) ethical problems that it uncovers. Despite this drawback, we maintain that, with some modifications, the ethical matrix can be a useful tool in debates in food ethics. We argue that useful modifications might be to include future generations amongst the stakeholders in the matrix, and to substitute the principle of solidarity for the principle of justice. (shrink)

Technology assessment (TA) is – for several reasons – not detachable from ethical questions. The development of institutions and concepts for TA, especially in the USA and Western Europe, has been marked by an increasing tendency to focus evaluative and normative questions. In the following paper, we point out, in as far as the common notions of TA are implicitly normative, why reflection upon conceptual options of TA inevitably leads to ethical questions, and that the key (...) question of participation necessarily comes up in the context of societal decisions made under conditions of risk or uncertainty. Arrangements of participatory and discoursive TA are referred to as possible applications of discourse ethics, but there are consequences to consider, which result from discourses in TA not being ideal discourses. Concepts and performance of TA arrangements on biotechnology and gene technology in different European countries are compared, analysing what similarities and differences can be found with respect to ethical clarification. Crucial questions of how to conceptualise participatory TA (pTA) and current topics in ethics of technology are shown to coincide. A proposal is presented of how these – theoretical normative and empirical descriptive – considerations can be used in a comprehensive conception for participatory and discoursive TA. (shrink)

The current model of technology assessment treats ethics itself as just another problem‐solving technology. Ethics should resist this model to play a more critical role in technology assessment by better understanding the complex relationship between society, medicine, and technology—and by recasting how problems are defined.

The current model of technology assessment treats ethics itself as just another problem‐solving technology. Ethics should resist this model to play a more critical role in technology assessment by better understanding the complex relationship between society, medicine, and technology—and by recasting how problems are defined.

Handling the impacts and consequences of technology has become a problem of political, social and scientific relevance since the Sixties. The earlier assumption that technological evolution would automatically lead to social and human progress in an emphatic sense can no longer be sustained. The ambivalence of technology has become a standing topic in the public, philosophical and scientific debate .In this situation new challenges to technology policy are emerging. Functions of an `early warning' with respect to the (...) risks or potentials of new technologies or to ways of avoiding or, at least, resolving technology conflicts by compromise have been postulated . Technology policy pursued by parliament or government, therefore, is in need of scientific consultation . Since the Seventies a number of institutions in this field have been founded , either primarily as parliamentary bureaus of knowledge-transfer to the decision-makers , as networks with a low degree of institutionalization or as independent scientific institutes .The scientific discussion on how to acquire and establish orientational knowledge for decision-makers facing the ambivalence of technology is sectoralized into two branches: the ethics of technology and technology assessment . These two branches are based on fundamentally different assumptions concerning how to give orientation to technology policy: the philosophical ethics, of course, emphasizes the normative implications of decisions on technology and the importance of moral conflicts , while technology assessment relies mainly on sociological or economic research .Both approaches have largely been developed and practised without regard to one another. In Germany, at the beginning of the Nineties the conceptual discussion around these questions was initiated. At first, a lot of misunderstandings appeared, both parties fundamentally criticizing each other, often one denying the competence of the other to deal appropriately with technology problems . In this paper the conflict is analyzed by looking at the situation in Germany, summarizing and weighing the main arguments which have been brought up by TA and the ethical approach to technology.As a result it will be shown that both are partly right, whereby the relative weight of both approaches in their capacity to give orientation is dependent on contextual circumstances. A non-reductionistic overall approach must take into account the normative aspects of the ethics of technology when handling moral conflicts as well as the need for operationalization, concreteness and established knowledge about the processes of “managing technology in society” postulated by TA. (shrink)

“HTA is a multidisciplinary process that summarizes information about the medical, social, economic and ethical issues related to the use of a health technology in a systematic, transparent, unbiased, robust manner. Its aim is to inform the formulation of safe, effective, health policies that are patient focused, and seek to achieve best value” (EUnetHTA 2007). Even though the assessment of ethical aspects of a health technology is listed as one of the objectives of a HTA (...) process, in practice, the integration of these dimensions into reports remains limited. The article is focused on four points: 1. the HTA concept; 2. the difficult HTA-ethics relationship; 3. the ethical issues in HTA; 4. the methods for integrating ethical analysis into HTA. (shrink)

Health technology assessment consists of thesystematic study of the consequences of theintroduction or continued use of the technology in aparticular context, with the explicit objective toarrive at a judgment of the value or merit of thetechnology. Ideally, it is aimed at assessing allaspects of a given technology or group oftechnologies, including non-technical, e.g.socio-ethical, aspects. However, methods for assessingsocio-ethical implications of health technology arerelatively undeveloped and few mechanisms exist totake action based on the results (...) of such evaluations.Still, the examples of cochlear inplants and other cases illustratethat HTA is not a matter of merely collecting thefacts about a technology. The facts must beplausible and relevant from a particular framework,which is not always shared by different groups. It ishere that socio-ethical aspects are encountered. Ifhealth technology assessment aims to enhance theaccountability of the decision making processregarding funding and use of health technology, it isa major challenge to assessors of health technologiesto deal adequately with existing value pluralism. Inthis respect interactive evaluation may have somethingto offer. (shrink)

A comprehensive assessment of a health technology requires that a wide variety of questions are addressed. These range from whether the use of a technology results in achievement of its intended effects at acceptable costs and without incurring undue risks to the patient, to whether its use may challenge existing social arrangements and values. Clearly, this is a major challenge, since it requires the use of quite different methods of inquiry. In the past decades, we have rarely (...) witnessed assessments where both types of questions were addressed in a balanced way. Rather, a wide gap exists between inquiries with a strong empirical focus and an almost complete neglect of underlying normative issues, and inquiries which are largely discursive, but with a serious disregard of relevant empirical data. The complex interplay between normative frameworks and empirical data in the assessment of health technologies is illustrated in two case studies: the assessment of surgical management of children with glue ears, and the assessment of Extra Corporeal Membrane Oxygenation in neonates. (shrink)

Interactive technology assessment is a novel approach to evaluating (health) technology, which philosophically draws from the works of Rawls and Habermas. That is, it seeks to organise a practical setting for discursive ethics in order to find a legitimate basis for policy to be pursued when the technology under scrutiny features a moral controversy. Interactive technology assessment involves a cycle of interviews with all stakeholders, who are explicitly asked to respond (anonymously) to the concerns (...) and issues raised by other participants. This cycle is completed repeatedly, so that a process of vicarious learning develops. This process aims at identifying issues agreed and disagreed upon, on the basis of which widely endorsed policy recommendations can be formulated. This chapter involves an interactive technology assessment of paediatric cochlear implantation. The rationale, the design, and the results are explained, as well as the main ethical aspects of the procedure. (shrink)

Interactive technology assessment (iTA) provides an answer to the ethical problem of normative bias in evaluation research. This normative bias develops when relevant perspectives on the evaluand (the thing being evaluated) are neglected. In iTA this bias is overcome by incorporating different perspectives into the assessment. As a consequence, justification of decisions based on the assessment is provided by stakeholders having achieved agreement. In this article, agreement is identified with wide reflective equilibrium to show that (...) it indeed has the potential of justifying decisions. We work out several conditions for this agreement to be achievable and just. (shrink)

Whether it is nuclear power, geo-engineering or genetically modified foods, the development of new technologies can be fraught with complex ethical challenges and political controversy which defy simple resolution. In the past two decades there has been a shift towards processes of Participatory Technology Assessment designed to build channels of two-way communication between technical specialists and non-expert citizens, and to incorporate multiple stakeholder perspectives in the governance of contentious technology programmes. This participatory turn has spurred a (...) need for new tools and techniques to encourage group deliberation and capture public values, moral and choices. This book specifically examines the ethical dimensions of controversial technologies, and discusses how these can be evaluated in a philosophically robust manner when the ones doing the deliberating are not ethicists, legal or technical experts. Grounded in philosophical pragmatism and drawing upon empirical work in partnership with citizen-stakeholders, this book presents a model called "Reflective Ethical Mapping" - a new meta-ethical framework and toolbox of techniques to facilitate citizen engagement with technology ethics. (shrink)

A comprehensive assessment of a health technology requires that a wide variety of questions are addressed. These range from whether the use of a technology results in achievement of its intended effects (e.g., better tumour control, pain relief, improved mobility, etc.) at acceptable costs and without incurring undue risks to the patient, to whether its use may challenge existing social arrangements and values (e.g., individual responsibility for preserving good health, the value of human life, etc.). Clearly, this (...) is a major challenge, since it requires the use of quite different methods of inquiry. In the past decades, we have rarely witnessed assessments where both types of questions were addressed in a balanced way. Rather, a wide gap exists between inquiries with a strong empirical focus and an almost complete neglect of underlying normative issues, and inquiries which are largely discursive, but with a serious disregard of relevant empirical data. The complex interplay between normative frameworks and empirical data in the assessment of health technologies is illustrated in two case studies: the assessment of surgical management of children with glue ears, and the assessment of Extra Corporeal Membrane Oxygenation in neonates. (shrink)

This paper proposes a framework for an ethical impact assessment which can be performed in regard to any policy, service, project or programme involving information technology. The framework is structured on the four principles posited by Beauchamp and Childress together with a separate section on privacy and data protection. The framework identifies key social values and ethical issues, provides some brief explanatory contextual information which is then followed by a set of questions aimed at the (...) class='Hi'>technology developer or policy-maker to facilitate consideration of ethical issues, in consultation with stakeholders, which may arise in their undertaking. In addition, the framework includes a set of ethical tools and procedural practices which can be employed as part of the ethical impact assessment. Although the framework has been developed within a European context, it could be applied equally well beyond European borders. (shrink)

Name der Zeitschrift: Jahrbuch für Wissenschaft und Ethik Jahrgang: 20 Heft: 1 Seiten: 293-302.

The widespread application of technology in health care has imposed a broad range of challenges. The field of health technology assessment (HTA) is developed in order to face some of these challenges. However, this strategy has not been as successful as one could hope. One of the reasons for this is that social and ethical considerations have not been integrated in the HTA process. Nowadays however, such considerations have been included in many HTAs. Still, the conclusions (...) and recommendations of the HTAs are not followed. The reason for this may be that the methods for integrating ethics for HTA are not sufficiently developed, or that they are not adequate. This article presents a supplementary approach to the ethical inquiry in HTA. It is argued that a value analysis is crucial in order to address the ethical issues of health care technology in a fruitful way and to make viable decisions about such technology. (shrink)

Synthetic biology is regarded as one of the key technosciences of the future. The goal of this paper is to present some fundamental considerations to enable procedures of a technology assessment of synthetic biology. To accomplish such an early “upstream” assessment of a not yet fully developed technology, a special type of TA will be considered: Prospective TA. At the center of ProTA are the analysis and the framing of “synthetic biology,” including a characterization and (...) class='Hi'>assessment of the technological core. The thesis is that if there is any differentia specifica giving substance to the umbrella term “synthetic biology,” it is the idea of harnessing self-organization for engineering purposes. To underline that we are likely experiencing an epochal break in the ontology of technoscientific systems, this new type of technology is called “late-modern technology.” —I start this paper by analyzing the three most common visions of synthetic biology. Then I argue that one particular vision deserves more attention because it underlies the others: the vision of self-organization. I discuss the inherent limits of this new type of late-modern technology in the attempt to control and monitor possible risk issues. I refer to Hans Jonas’ ethics and his early anticipation of the risks of a novel type of technology. I end by drawing conclusions for the approach of ProTA towards an early societal shaping of synthetic biology. (shrink)

Technology Assessment (TA) is a problem oriented endeavour dealing with political, societal, ecological, etc. problems. Only in rare cases is one individual scientific discipline sufficient to assess these problems. Usually the perspectives of different scientific disciplines have to be combined in order to develop interdisciplinary based recommendations to act. In this paper a quality controlled interdisciplinary discussion process is described which encourages an expert group to generate argumentation chains cross-cutting the disciplinary boundaries. The role of ethical reflection (...) in this procedure depends on the problem situation. Whenever a technical application is on the agenda which cannot be allocated to a so-called “business-as-usual” case, one would ask for ethical reflection. This contribution argues that this ethical reflection has to take place together with the interdisciplinary discussion due to two reasons. Firstly, the technical, economical, legal and social aspects are deeply cross-correlated with the ethical reflection. And secondly, participating in such interdisciplinary discussions enables an ethical reflection which keeps in touch with the real world. Two case studies dealing with robotics applications in health care are mentioned as examples for problem settings, in which interdisciplinary TA succeed in developing discipline-crossing argumentation chains. (shrink)

In many countries, health technology assessment organizations determine the economic value of new drugs and make recommendations regarding appropriate pricing and coverage in national health systems. In the US, recent policy proposals aimed at reducing drug costs would link drug prices to six countries: Australia, Canada, France, Germany, Japan, and the UK. We reviewed these countries’ methods of HTA and guidance on price and coverage recommendations, analyzing methods and guidance documents for differences in the methodologies HTA organizations use (...) to conduct their evaluations and considerations they use when making recommendations. We found important differences in the methods, interpretations of HTA findings, and condition-specific carve-outs that HTA organizations use to conduct evaluations and make recommendations. These variations have ethical implications because they influence the recommendations of HTA organizations, which affect access to the drug through national insurance and price negotiations with manufacturers. The differences in HTA approaches result from the distinct political, social, and cultural contexts of each organization and its value judgments. New cost-containment policies in the US should consider the ethical implications of the HTA reviews that they are considering relying on to negotiate drug prices and what values should be included in US pricing policy. (shrink)

That technologies may raise ethical issues is now widely recognised. The ‘responsible innovation’ literature – as well as, to a lesser extent, the applied ethics and bioethics literature – has responded to the need for ethical reflection on technologies by developing a number of tools and approaches to facilitate such reflection. Some of these instruments consist of lists of questions that people are encouraged to ask about technologies – a methodology known as the ‘Socratic approach’. However, to date, (...) these instruments have often not adequately acknowledged various political impacts of technologies, which are, I suggest, essential to a proper account of the ethical issues they raise. New technologies can make some people richer and some people poorer, empower some and disempower others, have dramatic implications for relationships between different social groups and impact on social understandings and experiences that are central to the lives, and narratives, of denizens of technological societies. The distinctive contribution of this paper, then, is to offer a revised and updated version of the Socratic approach that highlights the political, as well as the more traditionally ethical, issues raised by the development of new technologies. (shrink)

In this contribution, I wish to explore the potential of health technology assessment and ethics for increasing our capacity to pre-empt the shortcomings and undesired consequences of modern health care while maintaining its benefits. Central is the presumption that in case of some health problems this cannot be done unless we explicitly reconsider some features of the modern health care system, especially those related to its strong reliance on scientific rationality and the strong role played by medical professionals.So (...) as to both maintain the benefits of advanced health care and ensure that it produces less reason for concern, we need to reconsider our approach to rationality—and maybe even the way in which we build our health care system around that rationality. That is, we need to introduce an element of reflexivity. Two types of circumstances are being explored in which such reflexivity may prove worthwhile: controversies on side effects, and persistent problems encountered in optimising health care. Drawing on brief discussions of typical cases, we explore the potential of reflexive HTA and its methodical prerequisites.We conclude that ethicists may contribute to reflexive HTA, if they combine a hermeneutic—and often also participative—methodology with a solid understanding of the relation between the health problem under scrutiny and more general critique of the health care system. Insights from the areas of science and technology studies, as well as from social philosophy may be critical items in their tool kit. (shrink)

Name der Zeitschrift: Jahrbuch für Wissenschaft und Ethik Jahrgang: 20 Heft: 1 Seiten: 237-240.

The role of normative reflection and the possibilities of ethical inquiry in technology assessment have been under discussion in the TA community for several years. As an outcome of this discussion the necessity of explicitly dealing with normativity in TA has widely been acknowledged. However, it is still quite unclear in which way this should be done. This paper is dedicated to the role (and limitations) of ethical expertise in this field, especially in HTA. By methodological (...) analysis an approach is developed to show how entry points for ethical expertise could be identified. The result is that ethical expertise can inform moral debates by uncovering underlying assumptions, by making the normative structure of argumentation transparent, and by weighing the strength of the arguments. In this way moral debates in HTA can become more transparent and opened to argumentative reasoning instead of consisting of bargaining processes determined by power distributions. Ethical reflection, however, does not replace decision-making. (shrink)

BackgroundWhile evaluation of ethical aspects in health technology assessment has gained much attention during the past years, the integration of ethics in HTA practice still presents many challenges. In response to the increasing demand for expansion of health technology assessment methodology to include ethical issues more systematically, this article reports on a multi-stage study that aimed at construction of a framework for improving the integration of ethics in HTA.MethodsThe framework was developed through the following (...) phases: 1) a systematic review and content analysis of guidance documents for ethics in HTA; 2) identification of factors influencing the integration of ethical considerations in HTA; 3) preparation of an action-oriented framework based on the key elements of the existing guidance documents and identified barriers to and facilitators of their implementation; and 4) expert consultation and revision of the framework.ResultsThe proposed framework consists of three main components: an algorithmic flowchart, which exhibits the different steps of an ethical inquiry throughout the HTA process, including: defining the objectives and scope of the evaluation, stakeholder analysis, assessing organizational capacity, framing ethical evaluation questions, ethical analysis, deliberation, and knowledge translation; a stepwise guide, which focuses on the task objectives and potential questions that are required to be addressed at each step; and a list of some commonly recommended or used tools to help facilitate the evaluation process.ConclusionsThe proposed framework can be used to support and promote good practice in integration of ethics into HTA. However, further validation of the framework through case studies and expert consultation is required to establish its utility for HTA practice. (shrink)

This paper aims at discussing some contributions, limitations and opportunities that efficiency and equity studies could make to form a better understanding of ethical issues involved in health technology assessment (HTA). Prenatal detection of Down syndrome is used as a case study for further discussions regarding efficiency and equity, as well as other ethical principles including beneficence, non-maleficence and autonomy. The development and use of adequate methods and the need for context appraisal are two imperative issues (...) in this field of knowledge. The analysis of ethical implications in HTA should account for both. Economic evaluation methodologies have great potential in the assessment of some key ethical principles such as efficiency and equity but are of limited use concerning other fundamental principles. Social and individual values play a prominent role in this respect. (shrink)

This paper develops a hermeneutic technology assessment of quantum technologies. It offers a “vision assessment” of quantum technologies that can eventually lead to socio-ethical analysis. Section 2 describes this methodological approach and in particular the concept of the hermeneutic circle applied to technology. Section 3 gives a generic overview of quantum technologies and their impacts. Sections 4 and 5 apply the hermeneutic technology assessment approach to the study of quantum technologies. Section 5 proposes (...) distinguishing three levels in the analysis of the creation and communication of social meanings to quantum technologies: (a) fictions, (b) popularization, and (c) scientific journalism. Section 6 analyzes the results and defines some lines of action to increase social acceptance and trust in quantum technologies. The aim of this paper is to contribute to the debate on quantum technologies by enhancing the reflection on them and their potential, as well as illustrating the complexity of technological innovation and the need to shape it. (shrink)

The article sheds light on psychological and work science aspects of the design and utilization of service robots. An initial presentation of the characteristics of man–robot interaction is followed by a discussion of the principles of the division of functions between human beings and robots in service area work systems. The following aspects are to be considered: (1) the organisation of societal work (such as the different employment and professional profiles of service employees), (2) the work tasks to be performed (...) by humans and robots (such as handling, monitoring or decision-making tasks), (3) the possibilities and the limitations of realizing such tasks by means of information technology (depending, for example, on the motoric capabilities, perception and cognition of the robot). Consideration of these three design perspectives gives rise to criteria of usability. Current debate focuses on the (work science) principles of man–machine communication, though in future these should be supplemented with robot-specific criteria such as "motoric capabilities" or "relationship quality." The article concludes by advocating the convergence and combination of work science criteria with ideas drawn from participative design approaches in the development and utilization of service robots. (shrink)

Autonomous robots that are capable of learning are being developed to make it easier for human actors to achieve their goals. As such, robots are primarily a means to an end and replace human actions. An interdisciplinary technology assessment was carried out to determine the extent to which a replacement of this kind makes ethical sense in terms of technology, economics and legal aspects. Proceeding from an ethical perspective, derived from Kant’s formula of humanity, in (...) this article we analyse the use of robots in the care of the elderly or infirm and then examine robot learning in the context of this kind of cooperation. (shrink)

The worldwide COVID-19 pandemic has shed more light on the difficulty of making health care decisions integrating scientific knowledge and values associated to life and death issues, human suffering, quality of life, economic losses, liberty of movement, etc. But the difficulties related to health care decisions and the use of innovative drugs or technologies are not new, and many countries have created agencies that have the mandate to evaluate new technologies in health care. Health Technological Assessment (HTA) reports’ aim (...) is to guide the decision makers in these difficult matters. There are two ethical components in HTA. The first is the report’s presentation of an ethical evaluation of the technology. The second is the value-ladenness of the HTA decision-making process itself. When implicit value judgments are not elicited, the justification of the final decision cannot be transparent. The present paper aims to identify and elicit the implicit value-judgments related to each step of the HTA process. This research is grounded on an applied ethics decision-making paradigm based on the role of value judgments in the decision-making process. The first part discusses two different approaches to values and value judgments in HTA. In the second part, citations mentioning value judgments extracted from a systematic review on the integration of ethics into HTA were categorized to elicit the value judgments and their criteria for each different HTA decision-making steps. The results show that there are 18 decision-making steps in the HTA process where 23 implicit value-judgments can be recognized. The range of these value judgments encompasses the whole HTA process: from the initial request, the presenting of the principal issues, to the final report’s dissemination. Since stakeholders need to understand which value judgments the conclusion of a report relies on, eliciting the implicit value judgments in the HTA decision-making process should yield more transparency. (shrink)

The UK’s National Institute for Health and Care Excellence is responsible for conducting health technology assessment on behalf of the National Health Service. In seeking to justify its recommendations to the NHS about which technologies to fund, NICE claims to adopt two complementary ethical frameworks, one procedural—accountability for reasonableness —and one substantive—an ‘ethics of opportunity costs’ that rests primarily on the notion of allocative efficiency. This study is the first to empirically examine normative changes to NICE’s approach (...) and to analyse whether these enhance or diminish the fairness of its decision-making, as judged against these frameworks. It finds that increasing formalisation of NICE’s approach and a weakening of the burden of proof laid on technologies undergoing HTA have together undermined its commitment to EOC. This implies a loss of allocative efficiency and a shift in the balance of how the interests of different NHS users are served, in favour of those who benefit directly from NICE’s recommendations. These changes also weaken NICE’s commitment to AfR by diminishing the publicity of its decision-making and by encouraging the adoption of rationales that cannot easily be shown to meet the relevance condition. This signals a need for either substantial reform of NICE’s approach, or more accurate communication of the ethical reasoning on which it is based. The study also highlights the need for further empirical work to explore the impact of these policy changes on NICE’s practice of HTA and to better understand how and why they have come about. (shrink)

While evaluation of ethical aspects in health technology assessment has gained much attention during the past years, the integration of ethics in HTA practice still presents many challenges. In response...

PurposeThis conceptual paper aims to examine theoretical issues in the proactive ethical assessment of technology development, with a focus on uncertainty. Although uncertainty is a fundamental feature of complex technologies, its importance has not yet been fully recognized within the field of ethics. Hence, the purpose of this paper is to study uncertainty in technology development and its consequences for ethics.Design/methodology/approachGoing on the insight of various scientific disciplines, the concept of uncertainty will be scrutinised and a (...) typology of uncertainty is proposed and introduced to ethical theory. The method used is theoretical and conceptual analysis.FindingsThe analysis results in questions with regard to the collection of information about the object of assessment and the framework of assessment. Moreover, based on the insights of the analysis of uncertainty, it is argued that substantive ethical theories prove to be inapt for the ethical assessment of complex technology development and therefore require a concomitant procedural approach. The paper concludes with requirements for any future ethics of technology under uncertainty.Originality/valueThe value of the paper consists in establishing the need of researching and incorporating uncertainty in ethics. The results are consequently of practical and theoretical interest for anyone working in the field of ethics and technology. (shrink)

ML-HCAs have the potential to significantly change an entire healthcare system. It is not even necessary to presume that this will be disruptive but sufficient to assume that the mere adaptation of...

With a growing number of genetic tests becoming available to the health and consumer markets, genetic health care providers in Canada are faced with the challenge of developing robust decision rules or guidelines to allocate a finite number of public resources. The objective of this study was to gain Canadian genetic health providers' perspectives on factors and criteria that influence and shape resource allocation decisions for publically funded predictive genetic testing in Canada. The authors conducted semi-structured interviews with 16 senior (...) lab directors and clinicians at publically funded Canadian predictive genetic testing facilities. Participants were drawn from British Columbia, Alberta, Manitoba, Ontario, Quebec and Nova Scotia. Given the community sampled was identified as being relatively small and challenging to access, purposive sampling coupled with snowball sampling methodologies were utilized. Surveyed lab directors and clinicians indicated that predictive genetic tests were funded provincially by one of two predominant funding models, but they themselves played a significant role in how these funds were allocated for specific tests and services. They also rated and identified several factors that influenced allocation decisions and patients' decisions regarding testing. Lastly, participants provided recommendations regarding changes to existing allocation models and showed support for a national evaluation process for predictive testing. Our findings suggest that largely local and relatively ad hoc decision making processes are being made in relation to resource allocations for predictive genetic tests and that a more coordinated and, potentially, national approach to allocation decisions in this context may be appropriate. (shrink)

When one wants to use citizen input to inform policy, what should the standards of informedness on the part of the citizens be? While there are moral reasons to allow every citizen to participate and have a voice on every issue, regardless of education and involvement, designers of participatory assessments have to make decisions about how to structure deliberations as well as how much background information and deliberation time to provide to participants. After assessing different frameworks for the relationship between (...) science and society, we use Philip Kitcher's framework of Well-Ordered Science to propose an epistemic standard on how citizen deliberations should be structured. We explore what potential standards follow from this epistemic framework focusing on significance versus scientific and engineering expertise. We argue that citizens should be tutored on the historical context of why scientific questions became significant and deemed scientifically and socially valuable, and if citizens report that they are capable of weighing in on an issue then they should be able to do so. We explore what this standard can mean by looking at actual citizen deliberations tied to the 2014 NASA ECAST Asteroid Initiative Citizen forums. We code different vignettes of citizens debating alternative approaches for Mars exploration based upon what level of information seemed to be sufficient for them to feel comfortable in making a policy position. The analysis provides recommendations on how to design and assess future citizen assessments grounded in properly conveying the historical value context surrounding a scientific issue and trusting citizens to seek out sufficient information to deliberate. (shrink)

This book systematically addresses the issue of assessing the normative nature of visions of emerging technologies in an epistemologically robust way. In the context of democratic governance of emerging technologies, not only it is important to reflect on technologies' moral significance, but also to address their emerging and future oriented character. The book proposes an original approach to deal with the issue of "plausible" ethical evaluation of new technologies. Taking its start from current debates about Technology Assessment, (...) the proposed solution emerges as a combination of theoretical and methodological insights from the fields of Philosophy of Technology, Science and Technology Studies and a normative justification based on pragmatist ethics. The book's main contribution is to engage a diverse and interdisciplinary audience (ethicists, philosophers, social scientists, technology assessment researchers and practitioners) in a reflection concerning the epistemological challenges that are associated to the endeavour of appraising the moral significance of emerging technologies in the attempt of democratically governing them. It brings together concepts and methodologies from different disciplines and shows their synergy in applying them to two specific case studies of emerging biomedical technologies. (shrink)

Technoscience and technology assessment Content Type Journal Article DOI 10.1007/s10202-010-0080-8 Authors Karen Kastenhofer, Austrian Academy of Sciences Institute of Technology Assessment Strohg. 45/5 1030 Wien Austria Doris Allhutter, Austrian Academy of Sciences Institute of Technology Assessment Strohg. 45/5 1030 Wien Austria Journal Poiesis & Praxis: International Journal of Technology Assessment and Ethics of Science Online ISSN 1615-6617 Print ISSN 1615-6609 Journal Volume Volume 7 Journal Issue Volume 7, Numbers 1-2.

The World Health Assembly has encouraged WHO member-states to establish capacity in health technology assessment (HTA) as a support for achieving universal health coverage (UHC). Simultaneously, the WHO has stated that UHC is “a practical expression of the concern for health equity and the right to health.” This has prompted questions about potential tensions between priority-setting efforts and the right to health on the road to UHC. South Africa (SA) is an ideal setting in which to explore how (...) the priority-setting work of an HTA body may be integrated with an existing rights framework. (shrink)

In recent years, several authors have argued that the desirability of novel technologies should be assessed early, when they are still emerging. Such an ethical assessment of emerging technologies is by definition focused on an elusive object. Usually promises, expectations, and visions of the technology are taken as a starting point. As Nordmann and Rip have pointed out in a recent article, however, ethicists should not take for granted the plausibility of such expectations and visions. In this (...) paper, we explore how the quality of expectations on emerging technologies might be assessed when engaging in a reflection on the desirability of emerging technologies. We propose that an assessment of expectations’ plausibility should focus on statements on technological feasibility, societal usability, and desirability of the expected technology. Whereas the feasibility statement and, to a lesser extent, the usability statements are frequently quite futuristic, the claims on desirability, by contrast, often display a conservative stance towards the future. Assessing the quality of expectations and visions on behalf of emerging technologies requires, then, a careful and well-directed use of both skepticism and imagination. We conclude with a brief overview of the tools and methods ethicists could use to assess claims made on behalf of emerging technologies and improve the ethical reflection on them. (shrink)

Health technology assessment (HTA) is often biased in the sense that it neglects relevant perspectives on the technology in question. To incorporate different perspectives in HTA, we should pursue agreement about what are relevant, plausible, and feasible research questions; interactive technology assessment (iTA) might be suitable for this goal. In this way a kind of procedural ethics is established. Currently, ethics too often is focussed on the application of general principles, which leaves a lot of (...) confusion as to what really is the matter in specific cases; in an iTA clashes of values should not be approached by use of such ethics. Instead, casuistry, as a tool used within the framework of iTA, should help to articulate and clarify what is the matter, as to make room for explication and consensus building. (shrink)