Aimee Zellers

Defense Date


Graduation Date

Spring 2015


Immediate Access

Submission Type


Degree Name



Health Care Ethics


McAnulty College and Graduate School of Liberal Arts

Committee Chair

Henk ten Have

Committee Member

Gerard Magill

Committee Member

James Swindal


Ethics Assessment, Health Technology Assessment, Nonlinear Approach


The primary question this dissertation aims to answer is how ethics can be meaningfully integrated into health technology assessment (HTA). The contribution of this dissertation is two-fold. The first is to provide an honest and critical evaluation of current HTA practices, including those that involve ethics assessments and that do not. This evaluation will identify gaps and deficiencies in current HTA practices. The second contribution of this dissertation is to propose an approach for meaningful ethics assessment. The nonlinear approach contains five methodologically sound phases aimed to support both ethics assessment and scientific progress. The approach will be applied to emerging genetic health technologies, with a specific hypothetical application to expanded genomes.

These contributions will be systematically addressed in the following chapters. The first chapter will provide a general introduction to the connection and relationship between technology and values. It will examine value statements and normative statements that are made about technology, including whether technology is value-neutral, value-free, or value-laden. This chapter will ultimately argue that technology is value-laden, and the relationship between society and technology is but two sides of the same coin. Chapter two will address current HTA practices in both the USA and Europe. A distinction between technology assessment (TA) and HTA will be reviewed, as well as a number of basic procedural aspects in HTA. Chapter three will critically assess the current methods of ethics assessment in HTA, including the role ethics plays, identify their shortcomings, and provide a justification for rethinking ethics in HTA. In chapter four, the foundations, methodology, benefits and limitations of the nonlinear approach are delineated. The nonlinear approach consists of five phases with methodologies grounded in multiple disciplines. A detailed description of the function and projected benefits of the nonlinear approach will be given in Chapter five. Chapter five will apply the nonlinear approach to an emerging genetic health technology. Chapter six will consist of a brief summary of the arguments, address the strengths, weakness and feasibility of nonlinear approach, as well as concluding remarks regarding the future genetic health technologies and the role of ethics assessment.