the committee does not attempt in this report to perform a comprehensive assessment of the performance of every social mechanism for deliberation of ethical issues, one of the background papers in this volume by Gray does assess some of the accomplishments, determinants of success, and views of participants in the National Commission and President's Commission. The accomplishments of other deliberative bodies described in this chapter are outlined in greater detail in Appendix A.

The social and institutional context within which bioethics deliberation takes place was described in Chapter 2. In this chapter, we are concerned with the vast array of specific responses and mechanisms that facilitate the public deliberation of ethical issues in biomedicine. Whether, and to what extent, the activities of these various groups and institutions have been effective is a separate question that receives attention in Chapter 5, where criteria for evaluating the effectiveness of the work of these bodies are set forth.

For organizational purposes, this chapter categorizes ethics bodies according to their source of sponsorship or authority: political and legal (e.g., federal commissions), professional and institutional (e.g., institutional review boards), or grassroots (e.g., individual and community initiatives). It will become obvious, however, that there is significant overlap in the functions served by the different mechanisms, an overlap that defies neat categorization. In some cases, there are functional similarities between mechanisms that have significant structural differences and operate in separate societal spheres. The mechanisms have been created to fulfill numerous functions-some very general, some quite specific, many interrelated-including the following:

  • to bring to the larger public the opportunity and the responsibility (that previously belonged to elite groups) to define ethical issues;

  • to identify ethical issues at stake in areas of societal controversy;

  • to undertake a careful analysis of an issue;

  • to develop and/or document areas of consensus;

  • to expose and document areas of disagreement;

  • to unify the expertise of authorities from a wide variety of relevant fields;

  • to represent competing interests;

  • to generate public awareness and debate;

  • to be a lightning rod for public concern;

  • to educate;

  • to correct misunderstandings and errors in reasoning;

  • to develop factual bases for public policy;

  • to offer guidance for decision making;

  • to develop recommendations for action;



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