Health technology assessment implementation: the politics of ethics.

Using a 2009 American debate on a federal public health recommendation on mammography screening for women under the age of 50 as a case study, it is argued that public acceptance of health technology assessment (HTA) depends on the ethical acceptability of its recommendations. At the same time, that acceptability cannot be separated from the politics and values of the health care system of which it is part. In the United States, those values display a sharp ideological split between a conservative individual-based ethic and a liberal community-oriented ethic. A clash of this kind cannot be solved by invocation of ethical principles when it is those principles themselves that are in conflict. Inevitably HTA acceptance is threatened by this conflict as is the fate of health care reform.