PART II
COMMISSIONED PAPERS



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Society's Choices: Social and Ethical Decision Making in Biomedicine PART II COMMISSIONED PAPERS

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Society's Choices: Social and Ethical Decision Making in Biomedicine This page in the original is blank.

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Society's Choices: Social and Ethical Decision Making in Biomedicine The second part of this report presents a series of essays commissioned by the committee on various aspects of the social and ethical dimensions of decision making in biomedicine. Altogether there are 12 essays; they are ordered according to the scope of the issues they address. The first several essays explore broad questions while the later essays are more narrowly focused on a specific aspect of decision making or a particular bioethics effort. Moral Epistemology Thomas Nagel provides a definition of moral knowledge, examines mechanisms for acquiring such knowledge, and considers the possibility of arriving at moral knowledge through some kind of intellectually defensible process. He relates these issues to the challenges faced by public ethics bodies in contemporary, pluralistic America as they seek to explain and justify their views to their fellow citizens. Public Moral Discourse Dan W. Brock describes some of the features of the nature of public ethics bodies-the different goals they pursue, their typical charge and composition, and the role in public policy that they typically play. He argues that the method by which ethics bodies have tended to address and reason about moral issues is fundamentally similar to the methods of moral philosophy, and explains why the substantive conclusions that public ethics bodies reach by this process are justified. The Value of Consensus Martin Benjamin examines the nature, value, and limits of consensus in bioethical deliberation. He describes various types of consensus, as well as notions such as compromise and majority rule, and raises normative and methodological issues to be explored by ethics bodies as they consider what role consensus should play in their deliberations. Bioethics Commissions: What Can We Learn from Past Successes and Failures? Bradford H. Gray provides an analysis of the lessons to be learned from the experiences of two earlier ethics commissions-the National Commission and the President's Commission-both of which are generally cited as successes. From a survey of the members and staff of these commissions, he draws conclusions about the senses in which these two commissions were successful and the reasons behind their successes and failures.

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Society's Choices: Social and Ethical Decision Making in Biomedicine Limiting Life-Prolonging Medical Treatment: A Comparative Analysis of the President's Commission and the New York State Task Force Baruch A. Brody compares the accomplishments of these two ethics bodies, one at a national level and one at a state level, in their different approaches to one issue: limiting life-prolonging medical treatment. He explains why the nature of their successes differed and explores the important connections between the role of an ethics body and the context in which it operates, and the structure and process of that body. The Formulation of Health Policy by the Three Branches of Government Lawrence Gostin explores the role of government in formulating health policy. He considers the kinds of health policy questions that different government bodies are best equipped to solve, the data that they need to do so, and the mechanisms for making that data available to decision makers. The Role of Religious Participation and Religious Belief in Biomedical Decision Making Charles M. Swezey provides a framework for understanding the complex relationship between religion and bioethical decision making. He identifies significant dimensions of religious belief, sketches the elements of decision making, and traces the interactions between the two to illuminate the impact of religious belief on the practice of modern medicine. Trust, Honesty, and the Authority of Science Steven Shapin explores the moral authority of scientists by way of an historical inquiry into their credibility. He describes how the credibility of scientific claims and the moral standing of those who make the claims have been intertwined in the past. He points to the modern disengagement of virtue and expertise-the weakening of trust relationships in science-as problematic to science. Institutional Ethics Committees: Local Perspectives on Ethical Issues in Medicine Elizabeth Heitman examines the historical development of institutional ethics committees and describes the roles of these committees in policymaking, education, and consultation on ethical issues in medical care. She provides a comprehensive account of the administrative aspects of institutional eth-

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Society's Choices: Social and Ethical Decision Making in Biomedicine ics committees and identifies issues that these committees will confront in the future, such as cost-containment, liability, and long-term care. The Ethical, Legal, and Social Implications Program of the National Center for Human Genome Research: A Missed Opportunity? Kathi E. Hanna provides a comprehensive history and description of the Ethical, Legal, and Social Implications Program of the National Center for Human Genome Research. She explores the program's role in policy debate about genetic technology, analyzes its strengths and weaknesses, and considers strategies for reshaping the program so that it can more effectively achieve its intended goals. AIDS, Ethics, and Activism: Institutional Encounters in the Epidemic's First Decade Ronald Bayer examines the role of consultation between ethicists and those at risk of HIV in the confrontation of critical policy questions raised by the HIV epidemic. He explores how the distinctive political context of this consultation-the intensity of the discussion, the political forces called into play, and the demands made and solutions sought by activists-have fostered an unusual series of institutional efforts to engage activists in the process of establishing guidelines for AIDS policy. "La Pénible Valse Hésitation": Fetal Tissue Research Review and the Use of Bioethics Commissions in France and the United States R. Alta Charo compares and contrasts the roles and experiences of bioethics commissions in France and the United States, focusing on both countries' efforts in the area of fetal tissue research. She explores the political and historical context for bioethical deliberation in the two countries and points to significant social conditions to which commissions may have to be responsive in order to succeed

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