In this contribution, I wish to explore the potential of health technology assessment and ethics for increasing our capacity to pre-empt the shortcomings and undesired consequences of modern health care while maintaining its benefits. Central is the presumption that in case of some health problems this cannot be done unless we explicitly reconsider some features of the modern health care system, especially those related to its strong reliance on scientific rationality and the strong role played by medical professionals.So as to (...) both maintain the benefits of advanced health care and ensure that it produces less reason for concern, we need to reconsider our approach to rationality—and maybe even the way in which we build our health care system around that rationality. That is, we need to introduce an element of reflexivity. Two types of circumstances are being explored in which such reflexivity may prove worthwhile: controversies on side effects, and persistent problems encountered in optimising health care. Drawing on brief discussions of typical cases, we explore the potential of reflexive HTA and its methodical prerequisites.We conclude that ethicists may contribute to reflexive HTA, if they combine a hermeneutic—and often also participative—methodology with a solid understanding of the relation between the health problem under scrutiny and more general critique of the health care system. Insights from the areas of science and technology studies, as well as from social philosophy may be critical items in their tool kit. (shrink)

Science and technology studies analyses of emerging forms of treatment often result in the detailed display of complexities and at times lead to explicit critiques of particular healthcare practices. Simultaneously, there seems to be an increasing interest in exploring more experimental engagements by STS researchers in the proactive construction of such practices. In this article, I explore the relevance of experimental interventions in health care practices for both these care practices and for issues of the normativity of STS research. By (...) analyzing my involvement in changes in the practice of hemophilia home treatment, I indicate how this care practice was reconfigured, partly by drawing on STS insights on the issue of compliance. I also claim that experimenting with forms of ‘‘artful contamination’’ allow STS researchers to do normativity in the practices they engage with. Such practices of interventionist STS research may be of value for refiguring debates in which constructivism has been accused of being normatively deficient. This may make interventionist STS research a fruitfully risky business. (shrink)