considers how they should guide the development of a priority-setting process for OHTA in particular.


The Process Must Reflect the Mission of OHTA

OHTA's priority-setting process must ensure that the priority rankings it produces are consistent with the agency's objectives. What are those objectives?

The goals and objectives of OHTA are those of a public agency charged with producing information about a medical technology. The information should support the public interest, and OHTA's process should provide the information as efficiently and effectively as possible.

Although specifying the public interest is not an appropriate task for this committee, there is little question that society has expectations of its health care system. An understanding of these expectations is relevant to the work of OHTA and should be incorporated in its proposed model of priority setting. These expectations are related to beliefs about what health care is to achieve and how the health care system is to achieve it—with beneficence, nonmaleficence, and fairness (the goal of distributive justice in the allocation of all resources).1

Four elements of the public interest deserve consideration in determining which set of technologies should take precedence when assessment resources are limited:

  • the extent to which health care services can reduce pain, suffering, and premature death; increase health, functional capacity, and life expectancy; or maintain the functioning of those who are permanently impaired;


In the bioethics lexicon, these requirements are often referred to as duties of the following sorts:

beneficence, to promote good care (or as it is sometimes expressed, do to others their good);

nonmaleficence, to prevent or avoid harms;

autonomy, the general duty to respect persons or, in its applications in health care, the duty to respect the right of self-determination regarding choices about one's life, mind, and body;

justice, not to discriminate on the basis of irrelevant characteristics (sometimes expressed as treating individuals [or equals] equally in morally relevant situations) or, more specifically and commonly, distributive justice, the duty to distribute health care resources in ways that are defensible, fair, not arbitrary, and not capricious (in other words, equitable).

This discussion is taken from the forthcoming IOM report Guidelines for Clinical Practice: From Development to Use.

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