FORMS OF AGREEMENT

Agreement among members of bioethics committees and commissions may take a number of forms. At one end of the spectrum is full agreement on both the substance of a recommendation and its supporting arguments. At the other is vote-taking and the group's endorsing the will of the majority. In between are ''overlapping consensus" and compromise.

Complete Consensus

A consensus is, most generally, an agreement-a collective unanimous opinion-among a number of persons. If, for example, members of an ethics committee immediately agree on a recommendation and its supporting values or principles, consensus is predeliberatively complete. The entire position-argument and conclusion-of each member is, at the outset, congruent with that of the others.

Predeliberative complete consensus will, for two reasons, be uncommon. First, questions directed to such committees are usually contested. Ethics commissions or committees are created when the larger group they represent must speak with one voice on complex ethical questions to which members or clients of these groups give uncertain or conflicting answers. Issues likely to elicit complete consensus at the beginning of a group's deliberations are, as a result, not often addressed to ethics committees. Second, committee members usually represent differing social or ethical viewpoints or differing areas of biomedical, social scientific, or other types of expertise, or both. It is, in part, the diverse and representative composition of such committees that lends special authority to whatever agreement emerges from their deliberations. At the same time, this diversity is unlikely to produce predeliberative complete consensus.

Yet if complete consensus rarely emerges at the beginning of a group's deliberations, it will, more often, develop toward the end. Consider, for example, questions so novel or puzzling that committee members have, at the outset, no firm positions on them. "This is not to say," as Jonathan Moreno puts it, "that they come with no views or principles in relation to the matter at hand, but rather that they do not hold them in such esteem that they are prepared to insist that their essence be represented in the solution" (Moreno, 1990a, p. 43). Here, open-minded, informed, mutually respectful, give-and-take discussion aimed at well-grounded agreement may produce convergence on both reasons and conclusion-complete consensus.

Still, such consensus will not be frequent. Committee members often bring differing moral outlooks or principles to the deliberations that affect their reasoning or conclusions. Moreover, individuals representing differ-



The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement