(on average, for two days nearly once a month) and in public; their work was carried out by a multidisciplinary staff; and they had "action-forcing power" (that is, although the commissions could not issue regulations, any federal agency to which they made recommendations was required to publish the recommendations and then respond within a specified time, either adopting the recommendations or explaining why they had been rejected).

There were also some marked differences between the two commissions: the mandate of the President's Commission was considerably broader, and it operated independently of any department or agency; no new members were added to the National Commission during its four-year life, whereas only three of the original members served throughout the life of the President's Commission; and the staff of the President's Commission-which began with much greater expertise in bioethics than the National Commission staff-was divided into working groups for the various reports, meaning that many worked only on specified topics with no involvement in other reports that concerned unrelated topics.

The President's Commission mandate was broader, more responsive to varied public concerns, and thus more publicly visible. Its first publication, Defining Death (1981), was eagerly awaited by various professional groups and legislators who had been involved in ongoing debate over policies that differed in only minor respects. The report presented a proposed resolution of the policy issues, and it also presented two very important consensus documents: (1) a new model statute that was endorsed by key professional groups (the American Bar Association, the American Medical Association, and the National Conference of Commissions on Uniform State Laws) and (2) a comprehensive statement of the criteria for the determination of death, which was endorsed by 56 coauthors, including virtually all of the physicians who had written about the subject in the United States. Thus, this publication eliminated the perception that the relevant professionals could not agree as to who should count as having died and what should count as a good statute, factors that had posed barriers to adoption of legislation in many states. The criteria for determination of death were also published shortly thereafter (AMA, 1981), which led to widespread awareness of the report itself.

Many of the later reports were awaited by engaged and eager audiences, although these concerned publics were smaller or less visible than the audience that welcomed Defining Death. In the last month of its term, the President's Commission published two reports that had broader appeal and receptive audiences: Deciding to Forego Life-Sustaining Treatment and Securing Access to Health Care. The former document had been circulated to hundreds of concerned citizens in draft and it included not only clear recommendations about practice but also extensive appendices outlining palliative care, statutes on advance directives, and policies on foregoing

The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement