Appraisal of: Droste S, Dintsios CM, Gerber A. Information on ethical issues in health technology assessment: How and where to find them. Int J Technol Assess Health Care 2010; 26(4): 441–449.

Short description: 

The aim of the article is to present a procedure to identify information on ethical implications of the use and value-related decision-making in the assessment of health technologies. The purpose of the project is to develop, propose and test a step-by step workflow adapted to the specific issues of information on ethical issues (searching for arguments and qualitative data).

The article provides information on the background of developing the methodological approach as well as on the 8 working steps - Step 1 “Translation of the search question using the PICO scheme and additional components” to Step 8 “Final quality check and calculation of precision and recall”. The article is supplemented by the application results of the example “Ethical issues of autologous stem cell transplantation in metastatic breast cancer”.

Limitations stated by the author(s): 
  • Not all ethical issues related to health technologies can be identified by means of the approach described.
  • Some ethical issues cannot be found with systematic approaches - additional non-systematic searching may be useful.
  • The ethical issues relevant to the health technology investigated should be known in more detail before starting the systematic information retrieval.
  • Alleged innovations cannot be identified as such by the methodological approach.
Limitations stated by the reviewer(s): 
- Reference(s) to the validation work could have been provided. - The authors claim in the objective that if choosing the proper methodological approach: the central ethical dimensions then should be answerable. This seems like a too strong claim, what the authors do is to provide a brilliant methodological approach to address central ethical dimensions, to the extent there is anything published concerning these. Whether that answers ethical concerns is to some extent another matter and might call for a separate ethics analysis. Both since the sources might give conflicting answers, or give no answers at all. - Lack references to the database Philosopher’s index which in some cases might provide sources for a more general but relevant ethical discussion.
Study Type: 
Single study