ROBERT M. VEATCH
Inevitably a Value Judgment
"Technology assessment" is a systematically ambiguous term. Its ambiguity causes serious problems for policy makers and clinicians. On the one hand, "assessment" sometimes refers to the scientific study of the potential effects of a medical intervention. As such, technology assessment is often thought in the ideal to be scientific, objective, and value-free. On the other hand, "assessment" sometimes refers to judgments about the benefits and harms anticipated from medical interventions and when they should be pursued. They attempt to tell when a treatment is "medically indicated," "appropriate," or a "treatment of choice." They attempt to tell how patients should be "managed." 1 In this second sense technology assessment necessarily involves value judgments. Even in the ideal case deciding that something is beneficial or harmful, deciding something is indicated or ought to be used in particular circumstances always has to involve judgments about values that in principle cannot be determined by science alone. 2 Words like "beneficial," "harmful," "indicated," and "ought" necessarily convey evaluations that go beyond the scope of what modern practitioners of science consider scientific.
Determining what the expected effect of an intervention will be can, in principle, never tell whether that effect is good or bad, to be preferred or not. It can never tell how the effect compares, in evaluative terms, with other options. Any assessment of technology assessment will have to provide an adequate understanding of the relation between knowing the effects of a treatment and knowing how valuable the treatment is. Without knowing the value of the treatment one can, in principle, never know whether the treatment is worth pursuing.
The critical question for this project is, Is technology assessment supposed to provide facts without value judgment, or is it supposed to provide the necessary value framework for making medical decisions? The received wisdom