It is acknowledged that health technology assessment (HTA) is an inherently value-based activity that makes use of normative reasoning alongside empirical evidence. But the language used to conceptualise and articulate HTA's normative aspects is demonstrably unnuanced, imprecise, and inconsistently employed, undermining transparency and preventing proper scrutiny of the rationales on which decisions are based. This paper – developed through a cross-disciplinary collaboration of 24 researchers with expertise in healthcare priority-setting – seeks to address this problem by offering a clear definition of key terms and distinguishing between the types of normative commitment invoked during HTA, thus providing a novel conceptual framework for the articulation of reasoning. Through application to a hypothetical case, it is illustrated how this framework can operate as a practical tool through which HTA practitioners and policymakers can enhance the transparency and coherence of their decision-making, while enabling others to hold them more easily to account. The framework is offered as a starting point for further discussion amongst those with a desire to enhance the legitimacy and fairness of HTA by facilitating practical public reasoning, in which decisions are made on behalf of the public, in public view, through a chain of reasoning that withstands ethical scrutiny.

Prior research on self-other differences involving risk have found that individuals make riskier decisions for others than for the self in situations where risk taking is valued. We expand this research by examining whether the direction of self-other differences reverses when risk aversion is valued, as predicted by social values theory (Stone & Allgaier, 2008). Two studies tested for self-other differences in physical safety scenarios, a domain where risk aversion is valued. In Study 1, participants read physical safety and romantic relationship scenarios and selected what they would decide for themselves, what they would decide for a friend, or what they would predict their friend would decide. In Study 2, participants read public health scenarios and either decided or predicted for themselves and for a friend. In keeping with social values theory, participants made more risk-averse decisions for others than for themselves in situations where risk aversion is valued (physical safety scenarios) but more risk-taking decisions for others than for themselves in situations where risk taking is valued (relationship scenarios). Further, we show that these self-other differences in decision making do not arise from incorrectly predicting others’ behaviors, as participants predicted that others’ decisions regarding physical safety scenarios would be either similar (Experiment 1) or more risk taking (Experiment 2) than their own decisions.

The ‘death of evidence’ issue in Canada raises the spectre of politicized science, and thus the question of what role social values may have in science and how this meshes with objectivity and evidence. I first criticize philosophical accounts that have to separate different steps of research to restrict the influence of social and other non-epistemic values. A prominent account that social values may play a role even in the context of theory acceptance is the argument from inductive risk. It maintains that the more severe the social consequences of erroneously accepting a theory would be, the more evidence is needed before the theory may be accepted. However, an implication of this position is that increasing evidence makes the impact of social values converge to zero; and I argue for a stronger role for social values. On this position, social values (together with epistemic values and other empirical considerations) may determine a theory's conditions of adequacy, which among other things can include considerations about what makes a scientific account unbiased and complete. I illustrate this based on recent theories of human evolution and the social behaviour of non-human primates, where some of the social values implicated are feminist values. While many philosophical accounts (both arguments from inductive risk and from underdetermination) conceptualize the relevance of social values in terms of making inferences from evidence, I argue for the need for a broader philosophical framework, which is also motivated by issues pertaining to scientific explanation.

With twentieth- and twenty-first-century philosophy of science's unfolding acceptance of the nature of scientific inquiry being value-laden, the persistent worry has been that there are no means for legitimate negotiation of the social or non-epistemic values that enter into science. The rejection of the value-free ideal in science has thereby been coupled with the spectres of indiscriminate relativism and bias in scientific inquiry. I challenge this view in the context of recently expressed concerns regarding Canada's death of evidence controversy. The worry, raised by Stathis Psillos, is that as constructivist accounts of science demoted the previously secure status of evidence for drawing justified conclusions in science, we were left with no rational delineation between the right and wrong values for science. The implication for the death of evidence controversy is that we may have no rational grounds for claiming that the Canadian Government is wrong to interfere with scientific enterprise. But he does offer another avenue for reaching the conclusion that the wrong social values are directing the current stifling of some sectors of Canadian science. Psillos draws from standpoint epistemologies to devise a salient defence of ‘valuing evidence’ as a universalizable social value. That is, government bodies ought to enable scientific research via adequate funding as well as political non-interference. In this paper, I counter that (i) non-epistemic values can be rationally evaluated and that (ii) standpoint epistemology's universalizable standpoint provides an inadequate framework for negotiating social values in science. Regarding (i), I draw from the evidence-based medicine debate in philosophy of medicine and from feminist empiricist investigations into the science–values relationship in order to make the argument for empirically driven value arbitration. If social values can be rationally chosen in the context of justification, then we can have grounds for charging the Canadian leadership with being ‘at war with science’. (ii) I further argue that my recommended empiricist methodology is preferable to Psillos's search for universalizable perspectives for negotiating social values in science because the latter method permits little more than the trivial conclusion that evidence is valuable to science.

This paper is meant to link the philosophical debate concerning the underdetermination of theories by evidence with a rather significant socio-political issue that has been taking place in Canada over the past few years: the so-called ‘death of evidence’ controversy. It places this debate within a broader philosophical framework by discussing the connection between evidence and theory; by bringing out the role of epistemic values in the so-called scientific method; and by examining the role of social values in science. While it should be admitted that social values play an important role in science, the key question for anyone who advocates this view is: what and whose values? The way it is answered makes an important epistemic difference to how the relation between evidence and theory is appraised. I first review various arguments for the claim that evidence underdetermines theory and shows their presuppositions and limitations, using conceptual analysis and historical examples. After broaching the relation between evidence and method in science by highlighting the need to incorporate epistemic values into the scientific method, my discussion focuses on recent arguments for the role of social values in science. Finally, I address the implications of the approach outlined for the current ‘death of evidence’ debate in Canada.

Disaster ethics is a developing field of inquiry recognizing the wide variety of ethical issues confronting various professionals involved in planning for and responding to different types of disasters. This article explores how ethical issues related to floods are addressed in academic literature. The review involved analysis of publications on ethics and floods identified in a systematic literature search of electronic databases that included sociological, biomedical, and geophysical sources. The review methods were guided by the PRISMA Statement on systematic reviews, adapted to this topic area, and followed by a qualitative analysis of the included publications. All articles were analyzed using NVivo software version 11. The qualitative analysis showed that further research is needed on the ethical issues involved in flood disasters. Ethical guidelines are needed for flood planners and responders that are based on the consistent application of well-established ethical principles, values, and virtues to the specific circumstances arising with each flood. Flexibility is required in applying such approaches. The results suggest that interdisciplinary collaboration (sociological, biomedical, geophysical, engineering, and ethical) could contribute significantly to the development of ethics in floods. (Disaster Med Public Health Preparedness. 2019;13:817–828)

Objectives: Value assessment frameworks have gained prominence recently in the context of U.S. healthcare. Such frameworks set out a series of factors that are considered in funding decisions. The UK's National Institute of Health and Care Excellence (NICE) is an established health technology assessment (HTA) agency. We present a novel application of text analysis that characterizes NICE's Technology Appraisals in the context of the newer assessment frameworks and present the results in a visual way.

Methods: A total of 243 documents of NICE's medicines guidance from 2007 to 2016 were analyzed. Text analysis was used to identify a hierarchical set of decision factors considered in the assessments. The frequency of decision factors stated in the documents was determined and their association with terms related to uncertainty. The results were incorporated into visual representations of hierarchical factors.

Results: We identified 125 decision factors, and hierarchically grouped these into eight domains: Clinical Effectiveness, Cost Effectiveness, Condition, Current Practice, Clinical Need, New Treatment, Studies, and Other Factors. Textual analysis showed all domains appeared consistently in the guidance documents. Many factors were commonly associated with terms relating to uncertainty. A series of visual representations was created.

Conclusions: This study reveals the complexity and consistency of NICE's decision-making processes and demonstrates that cost effectiveness is not the only decision-criteria. The study highlights the importance of processes and methodology that can take both quantitative and qualitative information into account. Visualizations can help effectively communicate this complex information during the decision-making process and subsequently to stakeholders.

This essay brings attention to the recent discursive turn in Russian politics that is reflected in the Kremlin's turn to issues of traditional values and morality. Expressed in Russia's domestic and foreign policies, this new “morality politics” is dated by the Pussy Riot trial in 2012 that the Kremlin used to advance its new discursive frame in the public sphere. Although not entirely new in its orientation, this new stage of “morality politics” differs from the earlier policy initiatives in its intensity, scope and political significance for the regime. The moralizing stance taken by the regime is accompanied by a divide and rule political tactic, whereby the establishment has tried to marginalize the protesters from the rest of the Russian public that the regime is attempting to reconsolidate based on traditional, conservative values. The essay interprets this recent morality turn as a strategy selected by the Kremlin to restore the regime's legitimacy that has been shaken by the protests of 2011–2012 and looks at the social and political consequences of the selected strategy.

Objectives: We assessed the impacts of a Citizens’ Reference Panel on the deliberations of a provincial health technology advisory committee and its secretariat, which produce, recommendations for the use of health technologies in Ontario, Canada.

Methods: A fourteen-member citizens’ reference panel was convened five times between February 2009 and May 2010 to participate in informed, facilitated discussions to inform the assessment of individual technologies and provincial health technology assessment processes more generally. Qualitative data collection methods were used to document observed and perceived impacts of the citizens’ panel on the health technology assessment (HTA) process.

Results: Panel impacts were observed for all technologies reviewed, at two different stages in the HTA process, and represented macro- (raising awareness) and micro-level (informing recommendations) impacts. These impacts were shaped by periodic opportunities for direct and brokered exchange between the Panel and the expert advisory committee to clarify roles, foster accountability, and build trust. Our findings offer new insights about one of the main considerations in the design of deliberative participatory structures—how to maintain the independence of a citizens’ panel while ensuring that their input is considered at key junctures in the HTA process.

Conclusions: Citizens’ panels can exert various impacts on the HTA process. Ensuring these types of structures include opportunities for direct exchange between citizens and experts, to clarify roles, promote accountability, and build trust will facilitate their impacts in a variety of settings.

Background: Identifying treatments that offer value and value for money is becoming increasingly important, with interest in how health technology assessment (HTA) and decision makers can take appropriate account of what is of value to patients and to society, and in the relationship between innovation and assessments of value.

Methods: This study summarizes points from an Health Technology Assessment International (HTAi) Policy Forum discussion, drawing on presentations, discussions among attendees, and background papers.

Results and Conclusions: Various perspectives on value were considered; most place patient health at the core of value. Wider elements of value comprise other benefits for: patients; caregivers; the health and social care systems; and society. Most decision-making systems seek to take account of similar elements of value, although they are assessed and combined in different ways. Judgment in decisions remains important and cannot be replaced by mathematical approaches. There was discussion of the value of innovation and of the effects of value assessments on innovation. Discussion also included moving toward “progressive health system decision making,” an ongoing process whereby evidence-based decisions on use would be made at various stages in the technology lifecycle. Five actions are identified: (i) development of a general framework for the definition and assessment of value; development by HTA/coverage bodies and regulators of (ii) disease-specific guidance and (iii) further joint scientific advice for industry on demonstrating value; (iv) development of a framework for progressive licensing, usage, and reimbursement; and (v) promoting work to better adapt HTA, coverage, and procurement approaches to medical devices.

Historically, the Kibbutzim in Israel were established as collective, socialist communities. However, since the 1980s, the Kibbutz movement has undergone profound social processes. One of the outcomes of these processes was the privatisation of the Kibbutz. The goal of this study was to examine the relationship between the socio-legal structure of the Kibbutz (i.e. non-privatised versus privatised) and the awareness, knowledge and usage of legal planning tools for old age. Using a quantitative research method, a closed questionnaire was designed and distributed to a non-probability convenience sample, consisting of 295 respondents, of them 137 (46%) from traditional Kibbutzim and 158 (54%) from privatised Kibbutzim. Five different legal tools were examined: private pension; private long-term care insurance; advanced health-care directive, will, and organ donation. According to findings, on average, members of privatised Kibbutzim reported higher levels of awareness, knowledge and usage regarding legal planning tools for old age. These findings support other studies that point to the relationships between societal values (collectivist versus individualistic) and social policies regarding older persons – in general, and legal policies in the field of law and ageing – in specific. It is expected that a shift toward a more individualistic value-based society will increase the awareness and usage of individually based legal planning tools for old age.