TABLE 1 Reports of the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research and the President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research

National Commission Reports

President's Commission Reports

Research on the Fetus, 1975

Defining Death, 1981

Protecting Human Subjects, 1981

Research Involving Prisoners, 1976

Compensating for Research Injuries, 1982

Research Involving Children, 1977

Making Health Care Decisions, 1982

Psychosurgery, 1977

Whistleblowing in Biomedical Research, 1982

Disclosure of Research Information Under the Freedom of Information Act, 1977

Deciding to Forego Life-Sustaining Treatment, 1983

Research Involving Those Institutionalized as Mentally Infirm, 1978

Implementing Human Research Regulations, 1983

Institutional Review Boards, 1978

Screening and Counseling For Genetic Conditions, 1983

The Belmont Report, 1978

Securing Access to Health Care, 1983

Ethical Guidelines for the Delivery of Health Services by DHEW, 1978

Splicing Life, 1983

The Special Study (Implications of Advances in Biomedical and Behavioral Research), 1978

Summing Up, 1983

This paper is written at the request of the IOM committee, which asked for an analysis of the lessons to be learned from the experience of two earlier commissions that are both generally cited as successes 1--The National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research (the National Commission) and the President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research (the President's Commission). The National Commission issued ten reports between 1975 and 1978; the President's Commission also issued ten reports (plus a summary report) between 1981 and 1983. (These reports are listed in Table 1.) This paper will explore the senses in which these two commissions were successful and the reasons behind their successes and failures.

WHAT MAKES A COMMISSION SUCCESSFUL?

The question of what makes a commission successful is far from straightforward. 2 A report that helps to break a policy impasse may be viewed as successful by advocates of one policy option and as a disaster by



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