bodies, and the like. This report explores how these bodies approach the task of deliberating ethical issues, and how their approaches reflect the character of our society.

SOURCES OF ETHICAL ISSUES IN BIOMEDICINE

The tasks of ethics bodies convened to address issues in biomedicine have originated from clashes of values, norms, principles, and practices that have occurred in a number of arenas, especially: biomedical research involving human subjects; health care decision making, delivery, and financing; advances in medical diagnostics and therapeutics; and academic industry relationships in biotechnology. From these arenas have come new technologies, the proper use of which is controversial; crises in resource allocation and perplexing questions of distributive justice; changes in the organization and delivery of health care and related concerns about the appropriate role of physicians; and financing challenges that have spawned new relationships of questionable appropriateness between researchers and their sponsors. It was in the arena of human studies research that the ethical dimensions of biomedicine and the need for public involvement in such ethical matters were first recognized.

Abuses of human research subjects by the Nazis during World War II outraged the public and stimulated formal inquiry into the inherent conflict in biomedical investigation between benefit to the subject and benefit to science and society. The Nuremberg Code of 1948, designed to be used as a standard by which to judge the actions of Nazi scientists, was the first formal enunciation of ethical standards that proscribed scientific zealotry and disregard for human consent and dignity. In the 1960s and 1970s, following revelations in the United States of such incidents as the Tuskegee syphilis study, federal regulations were issued to protect human research subjects. The National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research (National Commission), which operated between 1974 and 1978 and became one of the most well-known public ethics bodies, was influential in developing these regulations and in stimulating the design of localized bodies, known as institutional review boards (IRBs), for the protection of human research subjects.

Changes in health care delivery and financing have also raised ethical concerns that have been subject to public deliberation. Informed consent, the linchpin of regulations for research on human subjects, was at the heart of a movement during the 1960s and 1970s toward greater patient autonomy. At issue were questions of information disclosure, decisional authority, and patient self-determination. At the same time, specialized medical technology began to flourish, health insurance companies grew and began to exert influence on health care decisions, and health care



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