SOCIETY'S CHOICES -- Copyright -- Preface -- Acknowledgments -- Contents -- Executive Summary -- SOURCES OF ETHICAL ISSUES IN BIOMEDICINE -- THE SOCIETAL CONTEXT OF BIOETHICAL PROBLEM SOLVING -- SYSTEMATIC APPROACHES TO BIOETHICS -- THE SPECTRUM OF SOCIETAL RESPONSES -- Political and Legal Mechanisms -- Professional and Institutional Mechanisms -- Individual and Community Responses -- CRITERIA FOR SUCCESS -- Intellectual Integrity: Logic, Scholarship, and Sound Judgment -- Logic -- Scholarship -- Sound Judgment -- Sensitivity to Democratic Values: Respect, Representation, and Openness -- Respect for Affected Parties -- Representation of Diverse Views -- Open versus Closed Meetings -- Effectiveness: Communication, Authority -- Communication -- Authority -- Different Goals, Different Yardsticks of Success: Achieving Consensus, Achieving Results -- Can Bioethics Be Disadvantageous? -- CONCLUSIONS AND RECOMMENDATIONS -- A Multilevel Approach to Bioethics Deliberation -- Nongovernmental Organizations and Individuals -- States -- Advisory Bodies in Federal Agencies -- A Supra-agency Commission -- PART I -- 1 Introduction -- DEFINING "ETHICAL" ISSUES -- SOURCES OF ETHICAL ISSUES IN BIOMEDICINE -- Biomedical Research Involving Human Subjects -- Changes in Health Care -- Making Decisions About Health Care -- The Health Care System: Financing and Structure -- New Diagnostic and Therapeutic Capabilities in Medicine -- Academic-Industry Relationships in Biotechnology -- REFERENCES -- 2 The Social Context of Bioethical -- THE AMERICAN CHARACTER -- Ambivalence About Government -- The Political Process -- The Religious Sphere -- ACTORS SHAPING THE SOCIAL CONTEXT FOR BIOETHICS -- Minorities: A History of Distrust -- Women: A Struggle for Control -- Gays and Lesbians: A New Activism -- HEALTH CARE AND SCIENCE: SHAPING THE SOCIAL CONTEXT FOR BIOETHICS.

Patients, Employers, and Insurance Companies: Health Care Consumers -- Hospitals -- The Health Care Industry -- Biomedical Research: The Federal Government and Private Industry -- Funding of Scientific Research -- REFERENCES -- 3 Systematic Approaches To Bioethics -- ACADEMIC BIOETHICS -- Definitions -- Origins -- Contributions -- Contributions of Religious Ethicists to Biomedical Questions -- Dangerous Ways to Present Religious Ethics -- Hopeful Developments -- SCIENTISTS AND OTHER TECHNICAL EXPERTS -- Science as a Discursive Model -- Scientists' Ethical Intuition -- Facts and Values -- Outlook -- HEALTH CARE PROFESSIONAL EDUCATION -- Origins -- Contributions -- REFERENCES -- 4 The Spectrum of Societal Responses -- POLITICAL AND LEGAL MECHANISMS -- Commissions Established by Congress -- National Commission -- President's Commission -- Biomedical Ethics Board -- Ethics Bodies in the Executive Branch -- Ethics Advisory Board, DHEW -- Recombinant DNA Advisory Committee, NIH -- Ethical, Legal, and Social Implications (ELSI) Working Group, NCHGR and DOE -- Human Fetal Tissue Transplantation Research Panel, DHHS -- State Commissions -- New York State Task Force on Life and the Law -- New Jersey Bioethics Commission -- Analysis of Governmental Bodies -- Comparing the Commissions -- Location and Autonomy -- Courts, Regulation, and Legislation -- Courts as Ethical Decision Makers -- International Perspectives -- Models of National Deliberation on Bioethics -- Dimensions of Bioethics Commissions -- PROFESSIONAL AND INSTITUTIONAL MECHANISMS -- Professional Societies and Voluntary Organizations -- AMA -- ACOG -- NABER -- ACP -- Other Medical Associations -- Health Maintenance Organizations -- Challenges Presented by the Creation of Guidelines -- Institutional Review Boards and Institutional Guidelines -- Hospital Ethics Committees and Physicians.

Historical Development of Hospital Ethics Committees -- Roles of the HEC -- IOM and OTA -- Institute of Medicine -- Office of Technology Assessment -- Ethics Centers -- Hastings Center -- Kennedy Institute of Ethics -- Religious Groups -- INDIVIDUAL AND COMMUNITY RESPONSES -- Grassroots Efforts -- AIDS Grassroots Organizations -- Abortion Grassroots Organizations -- Community Prevention -- Assessing Genetic Risks -- Rationalizing Health Care Priorities -- REFERENCES -- 5 Criteria For Success -- INTELLECTUAL INTEGRITY -- Logic -- Scholarship -- Sound Judgment -- SENSITIVITY TO DEMOCRATIC VALUES -- Respect for Affected Parties -- Representation of Diverse Views -- Open Versus Closed Meetings -- EFFECTIVENESS -- Preconditions of Effectiveness -- Communication -- Authority -- Different Goals, Different Yardsticks of Success -- Achieving Consensus -- Achieving Specific Results -- Can Bioethics Be Disadvantageous? -- Diversion and Capture -- Methods and Evaluation -- REFERENCES -- 6 Conclusions and Recommendations -- INTERPRETING THE COMMITTEE'S CHARGE -- Spheres of Concern -- Novel Developments -- Innovations Already Integrated into Practice -- Aggregate Effect -- Organizational Innovation -- Limitations in Scope -- CRITERIA FOR EVALUATION -- Potential Yardsticks -- Applying the Yardstick -- A MULTILEVEL APPROACH TO BIOETHICS DELIBERATION -- RECOMMENDATIONS -- A Multitiered Response -- Nongovernmental Organizations and Individuals -- Professional Organizations -- Hospital Ethics Committees -- Institutional Review Boards -- Health Professional Educational Institutions -- The State Level -- The National Level -- Agency-level Advisory Bodies -- A Supra-agency Commission -- REFERENCES -- PART II COMMISSIONED PAPERS -- Moral Epistemology -- NOTES -- Public Moral Discourse -- SOME FEATURES OF PUBLIC MORAL DISCOURSE AS DONE BY ETHICS COMMISSIONS.

Goals of Ethics Commissions -- Typical Scope of Ethics Commissions' Concern -- Membership of Ethics Commissions -- METHODS OF MORAL REASONING-IN MORAL PHILOSOPHY AND IN ETHICS COMMISSIONS -- Deductivism -- Particularism -- JUSTIFICATION WITH CONSIDERED MORAL JUDGMENTS -- A Critical Screening Process -- Reflective Equilibrium -- Relativism and the Subjectivity of Moral Judgments -- The Appeal to an Overlapping Consensus -- CONCLUSION -- NOTES -- The Value of Consensus -- FORMS OF AGREEMENT -- Complete Consensus -- Overlapping Consensus -- Compromise -- Majority Rule -- STRATEGIC CONSIDERATIONS -- NORMATIVE CONSIDERATIONS -- Moral Pluralism -- Rationality and Reasonableness -- Bioethical Questions -- Need for Agreement -- Value of Consensus -- An Illustration -- PROBLEMS AND LIMITS -- Composition -- Deliberations -- Recommendations -- CONCLUSION -- NOTES -- REFERENCES -- Bioethics Commissions: What Can We Learn from Past Successes and Failures? -- WHAT MAKES A COMMISSION SUCCESSFUL? -- THE TWO ETHICS COMMISSIONS -- The Commissions' Mandates -- The Roles of Commissioners and Staff -- METHODS OF THIS INQUIRY -- Citations to Commission Reports -- Cites to National Commission Reports -- Cites to President's Commission Reports -- Views of Members and Staff -- WHICH REPORTS SUCCEEDED AND WHICH FAILED? -- The National Commission's Reports -- The Successes -- The Mixed Cases -- The Failures -- The President's Commission's Reports -- The Successes -- The Partial Successes -- The Dust Collectors -- Accounting for Success and Failure -- National Commission -- President's Commission -- LESSONS AND CONCLUSIONS -- Lesson One -- Lesson Two -- Lesson Three -- Lesson Four -- Lesson Five -- Lesson Six -- Lesson Seven -- ACKNOWLEDGMENTS -- NOTES -- Limiting Life-Prolonging Medical Treatment: A Comparative Analysis of the President's Commission and ...

ACCOMPLISHMENTS OF THE PRESIDENT'S COMMISSION -- ACCOMPLISHMENTS OF THE NEW YORK STATE TASK FORCE -- CONCLUSION -- NOTES -- The Formulation of Health Policy by the Three Branches of Government -- CHARACTERISTICS OF SOUND POLICY DEVELOPMENT -- GOVERNMENT BODIES AND THE CAPACITY TO ADDRESS HEALTH ISSUES EFFECTIVELY -- The Judiciary -- The Legislature -- The Executive -- CONCLUSION -- NOTES -- The Role of Religious Participation and Religious Belief in Biomedical Decision Making -- FACTORS IN RELIGIOUS BELIEF -- The Vision of God -- Good and Evil -- Religious Participation -- Sources of Knowledge -- Moral Guidance -- Summary -- THE ELEMENTS OF DECISION MAKING -- Moral Values and Situational Analysis -- Loyalties -- Human Agency -- Summary -- INTERACTIONS -- Vision and Loyalties -- The Other Factors of Belief -- Prophetic Protest, the Status Quo, and Apocalypticism -- Summary -- CONCLUDING OBSERVATIONS -- NOTES -- Trust, Honesty, and the Authority of Science -- WHAT IS THE BASIS OF SCIENTISTS' CREDIBILITY? -- TRUST AND THE QUALITY OF SCIENTIFIC KNOWLEDGE -- HONOR, HONESTY, AND FREE ACTION IN EARLY MODERN SCIENCE -- FROM VIRTUE TO VIGILANCE -- "AFTER VIRTUE" AND ITS EFFECTS -- NOTES -- Institutional Ethics Committees: Local Perspectives on Ethical Issues in Medicine -- THE HISTORICAL DEVELOPMENT OF INSTITUTIONAL ETHICS COMMITTEES -- ROLES OF THE IEC -- Policy -- Education -- Consultation -- ADMINISTRATIVE ASPECTS -- ISSUES ON THE HORIZON -- IECs in Long-Term-Care Facilities -- IECs' Liability for Malpractice and Other Legal Action -- IECs and Cost Containment -- Measuring the Effects of IECs -- NOTES -- REFERENCES -- The Ethical, Legal, and Social Implications Program of the National Center for Human Genome Research: ... -- A HISTORY OF BIOETHICAL DISCOURSE IN GENETICS IN PUBLIC POLICY -- The Ethical, Legal, and Social Implications Program.

Development of an Agenda.