Beyond the Black Box Approach to Ethics!; Comment on “Expanded HTA: Enhancing Fairness and Legitimacy”

Document Type : Commentary


1 National Centre for Priority Setting in Health-Care, Linköping University, Linköping, Sweden

2 University of Borås, Borås, Sweden

3 Division of Arts and Humanities, Department of Culture and Communication, Linköping University, Linköping, Sweden


In the editorial published in this journal, Daniels and colleagues argue that his and Sabin’s accountability for reasonableness (A4R) framework should be used to handle ethical issues in the health technology assessment (HTA)-process, especially concerning fairness. In contrast to this suggestion, it is argued that such an approach risks suffering from the irrrelevance or insufficiency they warn against. This is for a number of reasons: lack of comprehensiveness, lack of guidance for how to assess ethical issues within the “black box” of A4R as to issues covered, competence and legitimate arguments and finally seemingly accepting consensus as the final verdict on ethical issues. We argue that the HTA community is already in a position to move beyond this black box approach.


Main Subjects

  1. Daniels N, Porteny T, Urritia J. Expanded HTA: Enhancing Fairness and Legitimacy. Int J Health Policy Manag. 2015;5(1):1-3. doi:10.15171/ijhpm.2015.187
  2. Biron L, Rumbold B, Faden R. Social value judgments in healthcare: a philosophical critique. J Health Organ Manag. 2012;26(3):317-330.
  3. Hofmann B. Toward a procedure for integrating moral issues in health technology assessment. Int J Technol Assess Health Care. 2005;21(3):312-318.
  4. Saarni SI, Braunack-Mayer A, Hofmann B, van der Wilt GJ. Different methods for ethical analysis in health technology assessment: An empirical study. Int J Technol Assess Health Care. 2011;27(4):305-312. doi:10.1017/s0266462311000444
  5. Duthie K, Bond K. Improving ethics analysis in health technology assessment. Int J Technol Assess Health Care. 2011;27(1):64-70. doi:10.1017/s0266462310001303
  6. Heintz E, Lintamo L, Hultcrantz M, et al. Framework for systematic identification of ethical aspects of healthcare technologies: the SBU approach. Int J Technol Assess Health Care. 2015;31(3):124-130. doi:10.1017/s0266462315000264