began its transformation into the business-like enterprise it is today. Ethical aspects of the resulting specialization, fragmentation, depersonalization, and variable accessibility of health care became the topics put before such public ethics bodies as the President's Commission for the Study of Ethical Issues in Medicine and Biomedical and Behavioral Research (President's Commission), which operated between 1980 and 1983; institutional ethics bodies known as hospital ethics committees; and community-based groups of health care consumers.

Developments in the area of biotechnology have also raised publicly debated ethical quandaries. Some of these quandaries have reflected genuine societal uncertainty about the use of novel technologies; others have related to the propriety of financial relationships between scientists and biotechnology companies. Developments in genetic research illustrate the promise and hazard of scientific discoveries-at the same time that they offer the potential of an end to suffering from gene-linked disease, they also threaten our identity as humans. One product of this apprehension has been the creation of the Ethical, Legal, and Social Implications (ELSI) Program at the National Center for Human Genome Research. Illustrative of the ethical issues raised by the commercialization of scientific discoveries are the pricing and distribution of products developed with public funds and the degree to which they serve the public interest. Also of concern are the ethical issues raised by the increasing tendency of universities and government laboratories to establish closer ties with industry.

Our society's capacity for dealing humanely and wisely with the impact of technological and scientific innovation, in each of the above areas and in others, is enhanced by the creation of forums in which ethical deliberation can be carried out. The deliberation may draw on many resources: experience in the use of these technologies and in the practice of medicine; the personal values and life experiences of participants; bodies of thought, such as economics and the law, which reflect and systematize value-laden judgments; and the intellectual and scholarly resources of the field of ethics. Its character and form are inevitably influenced by the distinctive history and culture of our society.

THE SOCIETAL CONTEXT OF BIOETHICAL PROBLEM SOLVING

American history is replete with examples of stirring ethical debates that have mobilized huge numbers of citizens. Debates about child labor laws, women's suffrage, prohibition, and the abolition of slavery are illustrative. What stimulated these public deliberations in large part was what characterized this country at its founding: a strong will to reject tyranny, to self-govern, and to preserve individual liberty. The American penchant for celebrating the individual and the private fostered the growth and diversity



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