Whose Values Define Value? Procedural Justice and the Personal Utility of Clinical Genomic Testing

Assessment (HTA), and the value assessment frameworks that underlie this process, seek to systematically define the value of new health interventions in terms of benefits and costs.Watts and Newson aim to "critically assess the ethical grounds for including personal utility within HTA and thus to promote standardization of this concept" (Watts and Newson 2026, 7).Their analysis represents an important step toward longneeded clarification of the concept of personal utility, and their consideration of the ethical dimensions underlying value assessment and HTA decision-making is to be commended.Their granular analysis also raises larger underlying ethical questions in value assessment and HTA, that is-whose values should define value, and how should these decisions be made?Traditionally, health economists, clinicians and policymakers have determined the methods of value assessment and defined benefit narrowly in terms of morbidity and mortality.More recently, HTA bodies have recognized that this narrow definition of health fails to capture many benefits that patients and families value (Rand and Kesselheim 2021).However, instituting a fair process for determining how an expanded concept of benefit should be defined and whose perspectives should be prioritized at various stages of value assessment requires consideration of principles of procedural justice, including transparency, inclusivity, and impartiality (Bond et al. 2020).In this commentary, I discuss the procedural justice implications of Watts and Newson's analysis of the personal utility of clinical genomic testing (CGT), with a focus on their arguments for the role of patient perspectives in defining and measuring value.At the outset, Watts and Newson draw on the principle of respect for persons to justify incorporating personal utility in value assessment and HTA.They argue that this position recognizes "patients as persons whose evaluations of the worth of healthcare technologies are ethically relevant to formal assessments of their value" (Watts and Newson 2026, 11).The authors also, at least initially, appear to recognize the relevance of patient and family perspectives in assessing the magnitude of value associated with various dimensions of personal utility, stating that "studies of patient-reported personal utility show that many of