successful. The positive assessments focused on the report's quality-its "lucid, constructive analysis" and the survey research results it included and its value as an educational document. But the perception of most respondents was that the report had had little or no impact on professional practice ("Doctors don't take informed consent seriously and no amount of writing, however good, makes any difference"), and no one cited any specific public policy impact.

The other three partial successes—Securing Access to Health Care, Splicing Life, and Screening and Counseling for Genetic Disorders—followed a similar pattern. In each case, several respondents saw the report as having had a significant impact on bioethics and, in the case of Securing Access, on public discourse. But most respondents perceived little or no public policy impact.

Securing Access was praised for the data it brought together on the uninsured and for articulating what became an influential ethical argument about the access issue (stated in terms of societal obligations rather than individual rights). But some were critical of the report, feeling that it had been watered down at the insistence of the conservative Reagan-appointed commissioners, and several noted the report's lack of impact on public policy.

Splicing Life was also seen as a clear, careful, and thoughtful report that had included good material, been the subject of a Senate hearing, influenced public debate, and helped lead to the establishment of the Human Gene Therapy Subcommittee of the NIH Recombinant DNA Advisory Committee. But some respondents thought that the overall tone was perhaps too "soothing" with regard to the implications of the issues that it addressed. The main impact that most respondents cited was intellectual.

Screening and Counseling was praised for its characterization of the issues, for providing a good overview, for its foresightedness and comprehensiveness, and for having avoided the "abortion quagmire." But there was little sense that the report had had any substantial public policy impact, though the report has been rediscovered to some extent in recent years owing to developments in genetic screening for cystic fibrosis.

The Dust Collectors

Four reports of the President's Commission were seen by most respondents as having had little effect on public policy or on the field of bioethics and as having gone on the shelf to collect dust. These were the three reports on research with human subjects-the two biennial reports that were part of the commission's mandated oversight function, and the report on Compensating for Research Injuries—and the report on Whistle-Blowing.



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