Furthermore, it seems impractical to spend time and energy imagining potential dilemmas when we are already faced with so many. Hence, the concepts of "anticipation" and "recognition" were merged into "early recognition" for the purpose of the committee's deliberations.

Next, the committee was asked to propose processes and/or structures by which early recognition and response could be accomplished on an ongoing basis; the committee was not asked to resolve any particular issue or set of issues. This portion of the committee's charge reflects the idea that the need to anticipate new issues becomes less pressing if established processes exist to address issues promptly as they arise.

The committee was apprehensive about the wording of its charge, noting that not all scientific and technological "advances" are, in fact, advances. The word "advances" implies positive impact, which is not always the case for new technologies. With this in mind, the committee agreed that it was actually addressing "developments" in biomedical science and technology.

Spheres of Concern

Finally, the committee recognized that not all ethical quandaries that have confronted society in the context of biomedicine have resulted from a single radical change or the introduction of a unique new technology. Limiting discussion to single radical changes or unique technologies did not produce a useful boundary for the committee's mandate. Rather, it pointed to a need to define more carefully the variety of circumstances under which troubling social and ethical issues can arise. The committee identified four illustrative scenarios, which follow.

Novel Developments

Novel developments may raise unique ethical concerns that did not exist prior to their introduction. The controversy provoked by the recently reported cloning of human embryos is illustrative (Kolata, 1993). So too are developments in genetics, which raise new questions about the interplay of free will and genetic determinism in generating behavior and about the value of information about future health status.

Innovations Already Integrated into Practice

Innovations may diffuse into medical practice more rapidly than related ethical issues can be resolved. Last year's innovations sometimes become this year's practices, with application far outpacing our capacity as a society to cope with the ethical dimensions raised by these new practices.

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