Biomedical Politics (1991) / Chapter Skim
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Appendix A: The Public and the Expert in Biomedical Policy Controversies
Appendix A: The Public and the Expert in Biomedical Policy Controversies
Pages 323-331
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Appendixes
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This essay examines the developments that brought these two groups to their current positions as partners in the public policymaking process. QUESTIONING THE EXPERTS: THE CHALLENGE FROM LAYMEN By the end of the Second World War, science and technology had come to be seen as fundamental forces impelling social growth, whose prominence caused rising exhilaration and deepening apprehension.
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How could legislators or citizens retain firm control of the reins of social enterprises like government when experts held sway over society's most essential knowledge—the reach and limits of its technology? What would happen to democratic institutions if technological authority became subtly transposed into political power, with the expert piper increasingly calling the policy tune?
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Heinous experiments on prisoners during World War II by Nazi scientists and physicians had led to the formulation of a code to guide research on humans, which was presented at the Nuremberg war crimes trials. The 10 principles were the pillars of a protective wall of rights designed to secure the well-being of future research subjects.
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These experts now acknowledge that it is possible to share detailed scientific and technical knowledge and the resulting decisions that vitally concern a patient's health and life—with laypeople who are in uniquely vulnerable situations with respect to this knowledge and decision process. Thus, the authority of laypeople to help determine how science and technology would be developed and used was purchased initially with the coin of ethical assertion and political persuasion.
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For the first time, the federal government assumed a major role in delivering medical services. Medicine now became a public enterprise: as its benefits and costs increasingly caused public authorities and society to take notice, an array of new values, disciplines, and social institutions joined existing professional ones in shaping future actions.
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This transformation of viewpoint was not merely the result of growing social support. Rather, it represented an emerging public recognition that the activities of clinical medicine and medical science bore heavily on significant national goals, which justified public dialogue about the character, costs, and directions of those activities.
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Both groups have yet to sort out questions that repeatedly appear in contemporary biomedical policy debates such as those discussed in this volume. For the public, what kind of justification is necessary for a given interest group to place a particular subject on the public agenda?
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