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Open Access 17-06-2024 | Original Article

Understanding the Normativity of Health Technology Assessment: Ontological, Moral, and Epistemological Commitments

Authors: Bart Bloemen, Wija Oortwijn, Gert Jan van der Wilt

Published in: Health Care Analysis

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Abstract

The inherent normativity of HTA can be conceptualized as a result of normative commitments, a concept that we further specify to encompass moral, epistemological and ontological commitments at play in the practice of HTA. Based on examples from literature, and an analysis of the example of assessing Non-Invasive Prenatal Testing (NIPT), we will show that inevitable normative decisions in conducting an assessment commits the HTA practitioner to moral (regarding what makes a health technology desirable), ontological (regarding which effects of health technology are conceivable), and epistemological (regarding how to obtain reliable information about health technology) norms. This highlights and supports the need for integrating normative analysis and stakeholder participation, providing guidance to HTA practitioners when making normative choices. This will foster a shared understanding between those who conduct, use, or are impacted by assessments regarding what are conceivable and desirable outcomes of using health technology, and how to collect reliable information to assess whether these outcomes are (going to be) realized. It also provides more insight into the implications of different normative choices.
Footnotes
1
This metaphor, which we think nicely describes the task at hand in addressing the normativity of HTA, was inspired by an interesting paper discussing the normativity of Technology Assessment (TA): Lucivero, F., Delvenne, P., & Van Oudheusden, M. (2019). Making the Invisible Visible. TATuP, 28(1)
 
2
Ontology refers to the set of categories used to describe the nature of objects, their relations, and phenomena held to exist.
 
3
With ‘normative’ we refer to ideas about how things should be or how people should behave. These ideas can be formalized by norms and are expressed by normative judgments or acting in accordance with certain norms. In the context of HTA, ‘normative’ refers to ideas, norms, and standards that are tacitly understood within its practice as the right way to conduct assessments of health technology [20]. There are different types of norms that share a prescriptive and evaluative function, and moral norms (value judgments) are a subset of this [21]. For example, consider the difference between ‘this is a fair distribution of healthcare resources’ and ‘this body of evidence can be considered reliable’. Both express an evaluation, but the goal of the evaluation is different, i.e., one prescribes that you ought to consider a particular distribution of resources as morally acceptable, whereas the other prescribes that you ought to consider particular evidence as truthful. In HTA, because it informs public decision-making that has moral consequences, the justification of different norms always includes references to moral norms.
 
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Metadata
Title
Understanding the Normativity of Health Technology Assessment: Ontological, Moral, and Epistemological Commitments
Authors
Bart Bloemen
Wija Oortwijn
Gert Jan van der Wilt
Publication date
17-06-2024
Publisher
Springer US
Published in
Health Care Analysis
Print ISSN: 1065-3058
Electronic ISSN: 1573-3394
DOI
https://doi.org/10.1007/s10728-024-00487-x