Victims of war and accidents, including children, as well as a growing number of elderly people with amputations due to late consequences of diabetes are dependent on prostheses to maintain autonomy, quality of life, and social participation.
Arm and leg prostheses have made significant functional and aesthetic advances in recent decades. Projects such as INOPRO are expected to result in further improvements in the field of “smart” prostheses that adapt to the environmental context and its individual users.
However, it is not only technical and functional features that determine the acceptance and benefits of prostheses, but social, legal, and ethical aspects also play an important role. This doctoral thesis will consider these aspects from the perspective of health technology assessment (HTA). In Germany, HTA is primarily concerned with the medical benefits of medical devices, but there are efforts and international trends to further explore ethical, legal, and social aspects. The thesis aims to provide a case study related to these methodological discussions.
A review of ethical and legal aspects is intended to identify and discuss the widest possible range of aspects (e.g., human enhancement, [media-generated] expectations of users, risks of invasive prosthetic technologies, social perception of amputees and prosthesis users, liability issues of human-technology interaction, privacy in data-collecting prostheses). The ethical and legal aspect of reimbursement or fair access to prostheses will then be analyzed in more detail.
In the face of increasing expenditure in the German health care system, higher costs of innovative prostheses lead to the question of the economics of medical care. In addition to this economic dimension, which plays a role in the reimbursement decisions of health insurers, this includes a social and ethical dimension: the fair distribution of resources in a system based on the principle of solidarity. On the other hand, there is an ethical demand for the implementation of disability rights, the inclusion of amputees in all areas of life (sports, everyday life, work) with all available means. The question of how to deal with these two at some point conflicting claims should be discussed with all stakeholders. In addition to a legal and ethical analysis, empirical and participatory approaches will be used for this purpose (stakeholder workshop, interviews with users).
The work is intended to contribute to the methodological discussion about ethics in HTA (also whether the concept of RRI is a suitable approach), as well as to raise public and political awareness of the issue of justice in health care through the example of prosthetics.