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Society's Choices: Social and Ethical Decision Making in Biomedicine
Another complexity arises from the fact that public ethics bodies operate in a pluralistic society where citizens' values vary greatly. For example, agreement on issues that involve abortion is extremely difficult, if not impossible, due to the deep divisions in our society on this subject. In fact, partisan adherence to strongly held opinions on abortion played a major role in the failure of the Biomedical Ethics Board (BEB) and the Human Fetal Tissue Transplantation Research Panel (HFTTRP), as well as the failure of efforts to reestablish the Ethics Advisory Board (EAB).
The mandate given to a public ethics body will also affect the way in which the success of that body or its products are judged. One reason that the National Commission has been judged a success by many observers is that it led to revised regulations for human subjects research (OTA, 1993). However, that success might have been impossible without the action-forcing clause in the original law, which forced the Department of Health, Education, and Welfare either to accept the commission's recommendations or publicly state its reasons for not accepting them. Conversely, the HFTTRP was charged to respond to ten specific questions-a charge that stimulated the majority of panel members to develop responses to the individual questions rather than to provide comprehensive and consistent justifications for all of its conclusions (King, 1991.) Some observers believe that the report of this panel would have been more persuasive had it developed an analytical framework for considering the issue that took account of existing norms, methodologies, and cultural perspectives (King, 1991).
Baruch Brody in his background paper in this volume maintains that both context and mandate were important factors in the effectiveness of the three New York State Task Force reports, Do Not Resuscitate Orders, Life- Sustaining Treatment: Making Decisions and Appointing a Health Care Agent, and When Others Must Choose, as well as that of the President's Commission report, Deciding to Forego Life-Sustaining Treatment. The three reports of the New York State Task Force on the topic of life-sustaining treatment occasioned more controversy because they were focused on the development of proposed legislation-an activity that is frequently accompanied by conflict.
Finally, some public ethics bodies serve functions that they were not specifically mandated to serve. For example, a body convened to draft legislation may be unsuccessful in that regard but may increase public awareness of an issue through its deliberations. Consequently, the evaluation of the success of a particular public ethics body may be more meaningful if it also takes into account achievements that are incidental to or unrelated to a group's mandated function. It is also necessary to ask whether public ethics bodies are to be judged on the basis of overall effect or on the basis of their particular products. When evaluating the overall