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Society's Choices: Social and Ethical Decision Making in Biomedicine
specific goals such as education, influencing of public debate, and stimulation of various government actions, including legislation. These disparate efforts, which may be pursued separately or in concert, must be evaluated according to a variety of different standards.
Starting with the obvious, public ethics bodies should successfully discharge the specific mandates that they are given. If a body fails to do what is asked of it, either because of political paralysis (e.g., the BEAC) or inadequate leadership and staffing, it cannot be judged a success.
Mandate is relevant to the overall assessment of a public ethics body in another way. Depending on the circumstances, some specific objectives may be more difficult to achieve than others. For example, articulating the contours of an emergent consensus for educational purposes, while a demanding and important task, is not nearly as difficult as drafting legislation on controversial topics for a population divided by fierce ideological and religious differences. Assessments of a body's accomplishments should thus resemble the scoring of a diving judge: assuming comparable quality, a greater number of points should go to the more ambitious and difficult projects. Neither public criticism of a work nor political opposition to its agenda are reliably reflective of inadequacies in its process or product; rather, they may simply represent the cost of doing very difficult business under contentious circumstances (see the background paper by Brody).
Assessing the effectiveness of a public ethics body's efforts at educating the public, influencing public opinion, or stimulating government action is a complex task. In large measure, judgments can be made based on criteria discussed above-e.g., intellectual integrity, respect for democratic values, and so forth-but they should also depend on criteria that reflect the nature of specific activities of the body. Thus, educational projects should be judged in part according to pedagogic standards, while judgment of legislative efforts should reflect the quality of the legal craft presented.
Examples of highly successful educational ventures include the Danish Council of Ethics, described in Chapter 4, and several of the President's Commission documents, including Splicing Life, Making Health Care Decisions, and Deciding to Forego Life-Sustaining Treatments. Successful legislative and regulatory efforts include the work of the National Commission and the respective reports of the New York State Task Force on Life and the Law and the New Jersey Bioethics Commission on the issue of advance directives. An example of a problematic legislative effort is the New York State Task Force's proposal for a statute on "do not resuscitate" (DNR) orders. While the task force's recommendations and the ensuing legislation can be credited with fostering greater dialogue among patients, families, and physicians, the law's apparent insistence upon emergency cardiopulmonary resuscitation (CPR) in the absence of a documented DNR order has given rise to unanticipated and vexing problems related to the