. "Bioethics Commissions: What Can We Learn from Past Successes and Failures?." Society's Choices: Social and Ethical Decision Making in Biomedicine. Washington, DC: The National Academies Press, 1995.
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Society's Choices: Social and Ethical Decision Making in Biomedicine
The Commissions' Mandates
The National Commission's core focus was clearly on ethical issues in research involving human subjects. It was directed to issue reports on four types of subject populations (the fetus, children, the institutionalized mentally infirm, and prisoners), on institutional review boards that review the ethical acceptability of proposed research, and on the basic ethical principles that should underlie research involving human subjects. However, the National Commission was also asked to report on several other topics: psychosurgery, ethical issues in DHEW-supported health services programs, and the applicability of the Freedom of Information Act to research proposals submitted to NIH. Finally, the commission's mandate included Senator Walter Mondale's idea for a "Special Study" of the implications of new developments in biomedical and behavioral research.
The President's Commission had a more diverse mandate, which eventually included almost every burning bioethical issue (except abortion itself) on the policy horizon. Certain topics were assigned to the commission by the legislation that created it: informed consent in research and medicine, the definition of death (particularly for patients whose brain function had ceased but whose other major organ systems were still operating, often with mechanical assistance), genetic testing and counseling, differences in access to health services, and issues of privacy in research and medicine. It was also directed to report biennially on the adequacy of federal policies (and their implementation) for protection of human subjects. In addition, the authorizing statute gave the commission the mandate to "undertake an investigation or study of any other appropriate matter which relates to medicine or biomedical or behavioral research ... and which is consistent with the purposes of [the legislation]." As a result, the commission studied and issued reports on genetic engineering in humans (at the request of the White House), compensation for injuries to research subjects, and decision making for terminally-ill patients and seriously defective newborns. Significantly, as we shall see, this last topic, undertaken on the commission's own initiative, became the commission's most successful report.
The Roles of Commissioners and Staff
The commissions also differed with regard to bureaucratic location, who appointed the commissioners, and the ways the chairs and staff were selected. These differences, in turn, help account for some more subtle differences in the functioning of the two bodies. Both of these commissions issued reports that were innovative, well-documented, carefully argued, persuasive, and influential. But the relative strengths of the mem-