sus that has been gradually building and is now more or less in place. A good example of this kind of "consensus articulation" might be the President's Commission report on informed consent and truth telling in Making Health Care Decisions (1982).

More frequently, however, public ethics bodies are faced with the harder task of actually forging a consensus that does not yet exist. In some instances, a report can help create a societal consensus in spite of some lingering opposition. A good example of this is provided by the New York State Task Force report on Surrogate Parenting (1988). The task force members were initially deeply divided on this issue, but through a process of intense and thorough discussion and debate, they eventually reached a unanimous decision to void surrogacy contracts in New York. Eventually, legislation premised on the task force's recommendations was passed, albeit over the objections of civil libertarians, the surrogacy industry, and some couples and prospective surrogates who wished to engage in this practice. It would probably be accurate to say that a consensus now exists in New York on this issue, although on many such issues consensus is subject to changes in public opinion over time.

Consensus has been more difficult to achieve on other issues, such as federal funding for research on fetal tissue transplants. The NIH panel that addressed this question achieved a clear majority in favor of funding such research, but it could not reach consensus. Try as they might to separate the question of fetal tissue research from the ethics and politics of abortion, the panel was ultimately divided on the question, reproducing within itself the divisions haunting the larger society.

Likewise, the President's Commission report on Securing Access to Health Care (1983b) faced the daunting task of attempting to create societal consensus on an issue that had divided Americans for decades. Forging ahead in spite of conflicting interest groups (doctors, hospitals, pharmaceutical companies, consumers, etc.), the commission was able to achieve internal consensus on the ethical principles that should govern the process of health care delivery and reform. The problem, according to some critics, was that this consensus was achieved by divorcing health care ethics from health care politics; the resulting consensus was, they claim, too abstract to be compatible with any live option for health care reform. The critics conclude that, in contrast to many of its other distinguished reports, this volume of the President's Commission has had virtually no impact on the public debate over health care reform (Bayer, 1984).

Achieving Specific Results

Apart from the global objective of forging a consensus on difficult bioethical controversies, public ethics bodies also seek to achieve more



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