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The role of ethical analysis in conducting a health technology assessment of medical treatments for gender dysphoria

Part of: Special Collection - Methods

Published online by Cambridge University Press:  14 November 2022

Samuli I. Saarni Open the ORCID record for Samuli I. Saarni [Opens in a new window] ,
Susanne Uusitalo  and
Ilona Autti-Rämö
Samuli I. Saarni*
Affiliation:
Department of Psychiatry, University of Helsinki, Helsinki, Finland Department of Medical Ethics, University of Turku, Turku, Finland
Susanne Uusitalo
Affiliation:
Turku Institute for Advanced Studies, University of Turku, Turku, Finland Department of Philosophy, Contemporary History and Political Science, University of Turku, Turku, Finland
Ilona Autti-Rämö
Affiliation:
Council of Choices in Health Care, Ministry of Social Affairs and Health, Helsinki, Finland Children’s Hospital, Department of Child Neurology, University of Helsinki, Helsinki, Finland
*
*Author for correspondence: Samuli I. Saarni, E-mail: samuli.saarni@gmail.com
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Abstract

Objectives

Treatment seeking for gender dysphoria (GD) has increased manifold in western countries. This has led to increased interest on evidence-base of treatments, but also discussions related to human rights, identity politics, gender-related structures, and medicalization. Combining these discourses into coherent health policy is difficult. Health technology assessment (HTA) is the golden standard for assessing whether a medical intervention should be included in a health system. A comprehensive HTA should include medical, safety, and cost-utility perspectives, but often also ethical, societal, organizational, and legal concerns. Still, ethics is often omitted in practice. This paper aims to demonstrate how integrated ethical analysis influenced a HTA of complex and controversial topics like GD.

Methods

A HTA of medical treatments of GD was conducted using integrated ethical analysis based on the EUnetHTA-model. This integrates ethical thinking into the whole HTA, explicitly analyses ethical topics, and balances arguments using several ethical theories.

Results

Integrating ethics had a significant impact on the HTA process and recommendations. It influenced how the HTA was planned and executed, emphasized autonomy and justice when creating the recommendations, and helped the workgroup to understand the complexity of combining different stakeholders’ discourses. Tensions between scientific evidence, expectations, and values became explicit.

Conclusions

Comprehensive HTA provides an important, integrative approach to considering complex and controversial topics in health systems. HTA emphasizes multidisciplinary and multi-stakeholder approach but simultaneously forces a pragmatic, results-oriented, and evidence-based approach on all argumentation. Ethical analysis can facilitate interactions between stakeholders, bridge different discourses, and help formulate widely acceptable guidelines and policy decisions.

Keywords

ethicshealth technology assessmentEUnetHTAgender dysphoriatransgender
Type
Method
Information
International Journal of Technology Assessment in Health Care , Volume 38 , Issue 1 , 2022 , e82
Copyright
© The Author(s), 2022. Published by Cambridge University Press

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