SOME FEATURES OF PUBLIC MORAL DISCOURSE AS DONE BY ETHICS COMMISSIONS

Goals of Ethics Commissions

What are some of the different goals or aims that public ethics commissions typically have? First, they often are charged with developing relatively discrete legislation to deal with a particular ethical issue. For example, the President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research (hereafter President's Commission) addressed in its first study the definition of death and developed a proposal for a uniform statutory definition, which has subsequently been adopted by nearly all states. Even with this relatively narrowly focused outcome, the President's Commission evaluated alternative definitions of death, for example, the "whole brain" account, which it supported, and the "higher brain" account, which it rejected, and offered philosophical and policy arguments in support of its choice of the whole brain formulation.

Second, ethics commissions are sometimes charged with addressing specific unethical practices and recommending governmental responses to correct those practices. For example, the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research (hereafter National Commission) was established in large part as a response to a number of well-publicized examples of abuses of human subjects in research and to an influential article detailing such abuses.2A central component of the National Commission's recommendations was the establishment of Institutional Review Boards whose task is to assure that human subjects are properly protected. The National Commission also developed detailed guidelines and recommendations governing the use of specific populations in research. Here, too, the National Commission offered arguments in defense of its recommendations, and indeed in its Belmont Report developed the general moral principles on which its recommendations rested.

Third, an ethics commission may seek to have a broad and diverse influence on policy and practice with regard to a particular moral issue. For example, the President's Commission in its report, Deciding to Forego Life-Sustaining Treatment,3 sought a multifaceted impact on such practices and policies as institutional, especially hospital, policies that guide practice within particular health care institutions; court decisions that set the legal framework of permissible practice; and the beliefs and practices of physicians and other health care professionals. A part of the influence of the President's Commission's work on this issue derived from its prestigious nature as a nationally constituted body, as has no doubt been true of other ethics commissions. But the influence of its recommendations also derived



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