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. 2018 Oct;24(5):957-965.
doi: 10.1111/jep.12920. Epub 2018 Apr 3.

Evaluating Facts and Facting Evaluations: On the Fact-Value Relationship in HTA

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Free PMC article

Evaluating Facts and Facting Evaluations: On the Fact-Value Relationship in HTA

Bjørn Hofmann et al. J Eval Clin Pract. .
Free PMC article

Abstract

Health technology assessment (HTA) is an evaluation of health technologies in terms of facts and evidence. However, the relationship between facts and values is still not clear in HTA. This is problematic in an era of "fake facts" and "truth production." Accordingly, the objective of this study is to clarify the relationship between facts and values in HTA. We start with the perspectives of the traditional positivist account of "evaluating facts" and the social-constructivist account of "facting values." Our analysis reveals diverse relationships between facts and a spectrum of values, ranging from basic human values, to the values of health professionals, and values of and in HTA, as well as for decision making. We argue for sensitivity to the relationship between facts and values on all levels of HTA, for being open and transparent about the values guiding the production of facts, and for a primacy for the values close to the principal goals of health care, ie, relieving suffering. We maintain that philosophy (in particular ethics) may have an important role in addressing the relationship between facts and values in HTA. Philosophy may help us to avoid fallacies of inferring values from facts; to disentangle the normative assumptions in the production or presentation of facts and to tease out implicit value judgements in HTA; to analyse evaluative argumentation relating to facts about technologies; to address conceptual issues of normative importance; and to promote reflection on HTA's own value system. In this we argue for a(n Aristotelian) middle way between the traditional positivist account of "evaluating facts" and the social-constructivist account of "facting values," which we call "factuation." We conclude that HTA is unique in bringing together facts and values and that being conscious and explicit about this "factuation" is key to making HTA valuable to both individual decision makers and society as a whole.

Keywords: concepts; epistemology; ethics; evidence; facts; health technology assessment (HTA); philosophy; values.

Figures

Figure 1
Figure 1
Distinction between facts and values in the health technology assessment process
Figure 2
Figure 2
Various forms of values involved in different aspects of health care and its assessment. HTA, health technology assessment

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References

    1. Lincoln YS. Fourth generation evaluation: 1989: Sage.
    1. Richardson HS. Practical reasoning about final ends Cambridge University Press: 1997.
    1. Kiran A. Scaling values: a perspective from philosophy of technology In: The Ethics of Consumption. Springer; 2013:347‐352.
    1. Banta HD. Foreword. Poiesis Prax. 2004;2(2‐3):93‐95.
    1. Banta HD, Perry S. A history of ISTAHC. A personal perspective on its first 10 years. International Society of Technology Assessment in Health Care. Int J Technol Assess Health Care. 1997;13(3):430‐453. discussion 454‐62 - PubMed

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