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Society's Choices: Social and Ethical Decision Making in Biomedicine
Commission on Legal and Ethical Problems in the Delivery of Health Care—known informally as the New Jersey Bioethics Commission-was mandated to ''provide a comprehensive and scholarly examination of the impact of advancing technology on health care decisions" and specifically to recommend policies to the governor, the legislature, and the citizens of New Jersey (NJ. Public Law 1985, Ch. 363). The group was large (27 members) and included 4 legislators and 9 members designated from executive agencies and major statewide professional and health care organizations. Its membership, which included representatives from law, medicine, nursing, science, humanities, theology, health care administration, and the New Jersey Citizen's Committee, was appointed by the governor, the Senate president, and the speaker of the General Assembly (see Appendix A for further description of the Bioethics Commission).
Within its broad mandate, the commission chose to focus its half-dozen reports on three areas: surrogate motherhood (in light of the landmark Baby M case), decision making about medical treatment (especially the use of advance directives), and the determination of death. The commission also established ad hoc task forces on other topics (ethics, AIDS, protection of vulnerable subjects); these groups, which included noncommissioners, made recommendations to the parent body. Besides obtaining consultants' advice and supporting research (to supplement the work of its small staff of two to five professionals), the commission took testimony at public hearings. Its work resulted in considerable public and professional education on its topics in New Jersey and in the adoption of two statutes (on the determination of death and on advance directives for health care). However, conflicts within the commission and between the staff and commissioners (particularly the legislator members) brought its work to an end in 1991 after six years.
Analysis of Governmental Bodies
Experience with officially established and supported efforts to examine bioethical issues is too limited to justify definitive conclusions, but it is sufficient to support some general findings. Since the broadest and best documented experience involved the National Commission and the President's Commission, our analysis begins with them and then widens to encompass other federal and state panels.
Comparing the Commissions
The two national commissions had several features in common: both were made up of 11 people from a variety of fields (about half from medicine or research); they came from outside government; they met regularly