Society's Choices Social and Ethical Decision Making in Biomedicine (1995) / Chapter Skim
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5. Criteria for Success
5. Criteria for Success
Pages 150-167
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From page 150... ...
The background paper written by Gray, who attempts to compare the "success" of the National Commission and the President's Commission, highlights many of the problems inherent in the evaluation and comparison of even two commissions, especially when the groups each have multiple functions and operated at different periods of time. Given the multiplicity of functions that public ethics bodies can serve (as noted early in Chapter 4)
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From page 151... ...
Among the criteria used for evaluation of public ethics bodies are items bearing on integrity of the reasoning process, public education (i.e., how well a report articulates the nature of a controversy, competing values, and alternative solutions, as well as how effectively the report is disseminated) , and effectiveness (i.e., getting laws passed, forging a public consensus, etch Different reports of the same body, being aimed at different kinds of tasks, might well satisfy these criteria in different ways and to different degrees (see the background paper by Gray)
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From page 152... ...
Few thorough evaluations have been done on the success of various other bodies covered to deliberate social and ethical issues in biomedicine—bodies such as HECs, IRBs, professional societies, grassroots organizations, or special interest groups. In short, evaluative criteria and their specific weights depend crucially upon context, including the nature of the controversy, the specific tasks of the body, the social setting, legal environment, etc.
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From page 153... ...
Public ethics bodies should take care to identify separately the various disciplinary perspectives on an issue e.g., theological, ethical, economic, political, legal, medical, biological, epidemiological and to give each its due without mistaking one for another.
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From page 154... ...
If the membership of a public ethics body lacks this technical knowledge, it must consult with appropriate experts. Members and staff of public ethics bodies should be aware of empirical studies bearing on their topic.
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From page 155... ...
SENSITIVITY TO DEMOCRATIC VALUES Respect for Affected Parties In addition to "the best that has been thought" on an issue, public ethics bodies should also be attentive to all the significant contributors to the public conversation about an issue. Rather than simply fixing on and advancing their own preferred approach to a problem, members and staff should make an honest attempt to hear all plausible, responsible views.
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From page 156... ...
Although the facts are in dispute, a number of vocal African American clergymen protested that the planned distribution of Norplant was decided upon without adequate consultation with the African American community, and that it violated the ethical and religious norms of that community. Representation of Diverse Views Concern for affected parties, including minorities, the disenfranchised, consumers, and public interest groups, should manifest itself not only in listening to the experiences and concerns of a wide variety of people, but also in the presence of representatives of such groups within the composition of the public ethics body itself.
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From page 157... ...
The open meeting model is thus especially well-suited to the values of a democratic society. In addition to expressing and reinforcing democratic values, the model of openness may also foster the effectiveness of public ethics bodies, which provide an open forum for all interested parties to witness the deliberations leading to public policy recommendations.
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From page 158... ...
In sum, it should be noted that closed meetings, while they do not directly advance democratic values, are not necessarily incompatible with them. When public ethics bodies do hold closed meetings, it is important that they also use mechanisms such as open hearings and public release of preliminary findings and recommendations.
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From page 159... ...
In the future, public ethics bodies should take advantage of new information technologies, such as making documents available through computer networks and on CD ROM. In addition to the documents themselves, members and staff of public ethics bodies should attempt to disseminate the main ideas behind their findings through a wide variety of media, including newspapers, editorial columns, book reviews, radio interviews, professional journals, and public and professional issue forums.
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From page 160... ...
Thus, whatever may be the specific goals of a particular body, achieving consensus will usually be an explicit policy objective. As Martin Benjamin explains in his background paper, consensus in public ethics bodies make take a number of forms.
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From page 161... ...
Compromise, explains Benjamin, is another form of agreement that can occur in public ethics bodies. Central to the idea of compromise is mutual concession for mutual gain; people with opposing positions relinquish aspects of their positions to find some middle ground that is mutually satisfying.
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From page 162... ...
The critics conclude that, in contrast to many of its other distinguished reports, this volume of the President's Commission has had virtually no impact on the public debate over health care reform (Bayer, 1984~. Achieving Specific Results Apart from the global objective of forging a consensus on difficult bioethical controversies public ethics bodies also seek to achieve more
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From page 163... ...
Examples of highly successful educational ventures include the Danish Council of Ethics, described in Chapter 4, and several of the President's Commission documents, including Splicing Life, Making Health Care Decisions, and Deciding to Forego Life-Sustaining Treatments. Successful legislative and regulatory efforts include the work of the National Commission and the respective reports of the New York State Task Force on Life and the Law and the New {ersey Bioethics Commission on the issue of advance directives.
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From page 164... ...
The current debate over the term "futile," which partly defines the authority of physicians to discontinue life-sustaining care, is a pressing example of how an ethical definition impacts on the cost of medical care. Special interests can subvert the process of bioethical deliberation at every level described in this report.
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From page 165... ...
When the government is financially implicated, as with the use of "experimental therapies" in entitlement health care programs or in past research abuses where compensation may be due, the government is not a neutral party. Even when the state turns to grassroots bioethics for advice, there are risks: participation may serve a pacification function if the government controls the agenda and participants are confined to debating issues the outcomes of which are unthreatening to the government's interests.
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From page 166... ...
At the same time, in the process of examining alternative positions, many considerations are brought to light that illuminate and expand understanding of the moral problem. This, in public moral discourse, is an invaluable byproduct of the bioethicist's presence.
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From page 167... ...
New York, NY: New York State Task Force on Life and the Law. President's Commission (President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research)
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