of course, the main thesis of the paper. But I want in this conclusion to add a speculative suggestion relating to the structure of, and the processes used by, these two commissions. In particular, I want to suggest that their different contexts and roles made different structures and processes appropriate for these two groups.

If your role is to develop, and to serve as advocates for, legislation in a context in which there is much disagreement on the topic of the proposed legislation, it is probably very important that the many groups (including the religious groups) with the diverse views on the topic be represented in the process of developing the legislation so that as few as possible feel that the legislation is being imposed on them. It may well be a good idea to first try to work out a common legislative proposal in informal private discussions, allowing for less posturing and for more attempting to find a common consensus, and to present it for public discussion only after a common plan has emerged. Given the vagaries of legislative timetables and given the need to fashion further compromises in a legislative process, it is probably a mistake to set a firm date for the conclusion of activities.

The situation is very different if your role is to articulate and systematize a recently emerged consensus and to begin discussions of moving beyond the consensus. Here, what may be needed is a very public process, where the diverse groups appear and present their positions before a group of well-respected individuals (with a strong staff) who are good at listening and synthesizing. It is, moreover, easier to talk of a limited time frame for these activities.

These are, of course, very speculative claims, but I find them quite plausible. Moreover, they help complete the explanation of the successes of the two commissions. I do think therefore that they are deserving of serious consideration.



President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research, Deciding to Forego Life-Sustaining Treatment (Washington, D.C.: U.S. Government Printing Office, 1983).


The New York State Task Force on Life and the Law, Do Not Resuscitate Orders (New York: Task Force, 1986), Life-Sustaining Treatment: Making Decisions and Appointing a Health Care Agent (New York: Task Force, 1987), and When Others Must Choose (New York: Task Force, 1992). That last publication is supplemented by Supplement to Report and Proposed Legislation (New York: Task Force, 1993).


Meisel, A. "The Legal Consensus about Forgoing Life-Sustaining Treatment: Its Status and its Prospects" Kennedy Institute of Ethics Journal vol. 2 (1993) pp. 309-45.


President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research, Making Health Care Decisions (Washington, D.C.: U.S. Government Printing Office, 1982).


President's Commission for the Study of Ethical Problems in Medicine and Biomedi-

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