NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competencies and with regard for appropriate balance.

This report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.

The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under both the Academy's 1863 congressional charter responsibility to be an adviser to the federal government and its own initiative in identifying issues of medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medicine.

Support of this project was provided by the Howard Hughes Medical Institute and National Research Council, National Academy of Sciences/National Academy of Engineering independent funds, and Institute of Medicine independent funds.

Library of Congress Cataloging-in-Publication Data

Society's choices: social and ethical decision making in biomedicine / Ruth Ellen Bulger, Elizabeth Meyer Bobby, and Harvey V. Fineberg, editors; Committee on the Social and Ethical Impacts of Developments in Biomedicine, Division of Health Sciences Policy, Institute of Medicine.

p. cm.

Includes bibliographical references and index.

1. Medical ethics. 2. Bioethics. I. Bulger, Ruth Ellen. II. Bobby, Elizabeth Meyer. III. Fineberg, Harvey V. IV. Institute of Medicine (U.S.). Committee on the Social and Ethical Impacts of Developments in Biomedicine.

R724.S598 1995

174'.2—dc209439354

CIP

The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The image adopted as a logotype by the Institute of Medicine is based on a relief carving from ancient Greece, now held by the Staalichemuseen in Berlin.