Regulations can take several forms-instructions, findings, definitions of terms, and so on-but a prescribed set of actions, including solicitation of public comment, must take place before federal regulations become effective. It has become common for interested parties to pose legal challenges to regulations (in either their proposed or final form). These challenges may be made on several grounds-the law does not authorize them, they do not follow the law, the issuing process was faulty, and so on. Some of these issues also have strong ethical elements. For example, the Supreme Court has rejected challenges against several regulations issued by the Secretary of Health and Human Services that limited women's rights to abortion as established by Roe v. Wade.

Courts have to take the limited view imposed upon them by the case as presented and by precedent; legislatures are buffered by special interests and any legislation is inevitably marked by compromises. Public bioethical deliberation can provide the broader view that the courts, which are set up to focus on individual cases and circumstances, cannot easily provide and can attempt an impartiality that legislation cannot always achieve. The existence of bioethical opinion may inform the courts, as did the President's Commission opinion on foregoing life support in the Herbert case (California Court of Appeals, Barber v. Superior Court, 1983), and may influence the legislatures, as did the New York State Task Force on Life and Law.

International Perspectives 2

Bioethics is generally regarded as a subject first developed in the United States. Until recently, a clear majority of books and articles in the field was published here, and the number of academic departments, courses, and conferences was far greater in the United States than abroad. Similarly, the U.S. government took the lead in investigating bioethical issues and in issuing regulations when it established the National Commission and President's Commission in the 1970s. In the past few years, however, bioethics has rapidly internationalized. Hospitals the world over have sprouted ethics committees, new journals are appearing in foreign languages, and regional and international bioethics societies have been formed.

While the United States has been notable for launching new initiatives and sponsoring numerous activities on bioethics in the academic world, it has not been as active in the support of governmental bioethics activity. Since the demise of the President's Commission in 1983, the United States has had no national bioethics commission, despite the still-increasing public and academic fascination with bioethical issues. In Europe, govern-

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This section is based on research by committee member Daniel Wikler while he worked as a consultant to the Office of Technology Assessment.



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