1. the principles to be used for allocation of medical services and integration of costs with social and ethical considerations into clinical and allocation policy decisions; and

  2. issues related to reproduction and research and medical treatment of embryos and fetuses.

A high-level commission has several institutional advantages over efforts at a lower level, including greater visibility, higher prestige, greater capacity to address a broad mandate, and more independence. A centrally situated body would be readily available to work on complex issues and give coherent responses. A national body can more readily call upon the national and international expertise that is required for complicated and difficult issues; experts can function as commissioners, staff, witnesses, and/or authors of background papers. A national body is also in a better position to formulate and represent distinctively American views on bioethics, at a time when issues relating to biomedical research and applications are becoming increasingly internationalized.

National professional bodies may have the expertise to deal with social and ethical issues, but may lack the authority and legitimacy that comes from being authorized and appointed by the federal government. The National Commission and President's Commission demonstrated the effectiveness of federally appointed bodies in dealing with ethical issues.

The committee recommends that the federal government establish a public deliberative body (or bodies, depending on the breadth of the mandate to be addressed) for a limited term at the supra-agency level to consider social and ethical issues stemming from technological and organizational developments in biomedicine that are of concern simultaneously to several governmental agencies or are nationwide in scope.

The experience of BEAC should not be forgotten, however, in any vision of a national-level commission and the sorts of issues it might address. BEAC has been described as having "crashed on the shoals of abortion politics," an idea that raises the question of how another national-level commission might navigate through some of the issues that BEAC was convened to address. As Hanna and colleagues describe (1994), issues in which abortion is a factor may be issues of which public bioethics deliberation must simply steer clear. They suggest that abortion and issues involving abortion are issues that simply cannot be productively engaged at the present time because they elicit "strongly held incompatible views that rational people reach from different moral premises." Even if competing biases were equally balanced on a commission, opinions about abortion are usually so strongly held that it is unlikely that significant movement toward a middle ground could occur. At some time in the future, bioethi-



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