Multiple roles and successes in public bioethics: a response to the public forum critique of bioethics commissions

National bioethics commissions have been critiqued for a variety of structural, procedural, and political aspects of their work. A more recent critique published by Dzur and Levin uses political philosophy to constructively critique the work of national bioethics commissions as public deliberative forums. However, this public forum critique of bioethics commissions ignores empirical research in political science and normative claims that suggest that advisory commissions can and should have diverse of functions beyond that of being public forums. The present paper argues that the public forum critique too narrowly considers the roles that bioethics commissions can play in public bioethics and ignores the moral obligation of commissions to fulfill their mandates. Evaluations of commissions must consider that these institutions can serve in capacities other than those of a public deliberative forum and use additional measures to evaluate the multiple roles and successes of bioethics commissions in public policy.     

The primacy of the public: in support of bioethics commissions as deliberative forums

In a 2004 article, we argued that bioethics commissions should be assessed in terms of their usefulness as public forums. A 2006 article by Summer Johnson argued that our perspective was not supported by the existing literature on presidential commissions, which had not previously identified commissions as public forums and that we did not properly account for the political functions of commissions as instruments of presidential power. Johnson also argued that there was nothing sufficiently unique about bioethics commissions to make the public forum perspective particularly applicable. We respond by arguing that analysis of commissions' work as public forums fits well within the literature on commissions, especially on their agenda-setting functions, and that the political functions of commissions are often compatible with their functioning as public forums. We also demonstrate how the origins and concerns of bioethics make public forum analysis particularly applicable to bioethics commissions.     

探析美国国家生命伦理学委员会--历史沿革及启示

在一个没有单一国教或价值权威能全盘解决科技政策与价值问题的多元社会中,由政府设置公共论坛性质的政策咨询委员会,是一项值得采纳的作法.美国先后设立过6个国家生命伦理学委员会,探析它们的建立与变迁,可以为我国类似组织提供参考.     

Diversity and deliberation: bioethics commissions and moral reasoning

This article considers the sort of diversity in perspective appropriate for a presidential commission on bioethics, and by implication, high-level governmental commissions on ethics more generally. It takes as its point of comparison the respective reports on human cloning produced by the National Bioethics Advisory Commission, appointed by President Bill Clinton, and George W. Bush's President's Council on Bioethics, under the leadership of its original chair, Leon Kass. I argue that the Clinton Commission Report exemplifies forensic diversity (the type of diversity between contesting parties in a legal case), while the Kass Council Report exemplifies academic diversity (the diversity found in a medieval disputatio). Drawing upon Thomas Aquinas, I argue that the type of diversity most appropriate for such advisory bodies is deliberative diversity, which facilitates the President's process of taking counsel. After considering their respective charges, I suggest that neither the Clinton Commission nor the Kass Council possessed an adequate degree of deliberative diversity for their respective tasks.     

"Show me" bioethics and politics

Missouri, the "Show Me State," has become the epicenter of several important national public policy debates, including abortion rights, the right to choose and refuse medical treatment, and, most recently, early stem cell research. In this environment, the Center for Practical Bioethics (formerly, Midwest Bioethics Center) emerged and grew. The Center's role in these "cultural wars" is not to advocate for a particular position but to provide well researched and objective information, perspective, and advocacy for the ethical justification of policy positions; and to serve as a neutral convener and provider of a public forum for discussion. In this article, the Center's work on early stem cell research is a case study through which to argue that not only the Center, but also the field of bioethics has a critical role in the politics of public health policy.     

Emergency Research and Consent: Keeping the Exception from Undermining the Rule

Contemporary bioethics has been somewhat skewed by its focus on high-tech medicine and the resulting development of ethical frameworks based on an acute-care model of healthcare. Research and scholarship in bioethics have payed only cursory attention to ethical issues related to disability. I argue that bioethics should concern itself with the full range of theoretical and practical issues related to disability. This encounter with the disability community will enrich bioethics and, potentially, society as well. I suggest a number of items that the bioethics agenda should include, such as the development of a casuistry of the right to healthcare and to community integration and an advocacy role in fostering an understanding among the public and policy makers of the need to reform research and treatment related to disability.     

Disability: an agenda for bioethics

Contemporary bioethics has been somewhat skewed by its focus on high-tech medicine and the resulting development of ethical frameworks based on an acute-care model of healthcare. Research and scholarship in bioethics have payed only cursory attention to ethical issues related to disability. I argue that bioethics should concern itself with the full range of theoretical and practical issues related to disability. This encounter with the disability community will enrich bioethics and, potentially, society as well. I suggest a number of items that the bioethics agenda should include, such as the development of a casuistry of the right to healthcare and to community integration and an advocacy role in fostering an understanding among the public and policy makers of the need to reform research and treatment related to disability.     

Promises and perils of public deliberation: contrasting two national bioethics commissions on embryonic stem cell research

National bioethics commissions have struggled to develop ethically warranted methods for conducting their deliberations. The National Bioethics Advisory Commission in its report on stem cell research adopted an approach to public deliberation indebted to Rawls in that it sought common ground consistent with shared values and beliefs at the foundation of a well-ordered democracy. In contrast, although the research cloning and stem cell reports of the President's Council on Bioethics reveal that it broached two different methods of public deliberation--balancing goods and following an overarching moral principle--it adopted neither. Thereupon its primer mover, Leon Kass, influenced particularly by the approach of Leo Strauss, sought to develop a method of public deliberation guided by tradition and practical wisdom. When this failed, the Council fell back on a method that took account of shared fundamental values of a free democracy--a method remarkable akin to that employed by the National Bioethics Advisory Commission. Respect for diverse reasonable conceptions of the good in a democratic polity requires national bioethics commissions to seek and incorporate that which is valuable in opposing positions.     

Bioethics and the marginalization of mental illness

This paper explores why ethical issues associated with mental illness have been generally neglected in the literature and texts of the discipline of bioethics. I argue that the reasons for this are both philosophical and structural, involving the philosophical framework of principlism in bioethics, in particular the privileging of the principle of autonomy, and the institutional location and disciplinary boundaries of bioethics as a profession. Other contributing factors include developments outside of bioethics, in medicine and law and in the delivery patterns and funding sources of mental health services, and above all the pervasive stigma that attaches to mental illness. My goal is to show both how the attention bioethics could bring would benefit this neglected area of health care, and why attending to the issues surrounding mental illness would benefit bioethics in meeting its professional obligations as the public voice on matters of ethical significance in health care.     

Reflections on public bioethics: a view from the trenches

For many reasons, and more than its predecessors, the President's Council on Bioethics has been the subject of much public attention and heated controversy. But little of that attention and controversy has been informed by knowledge of the Council's mission, its ways of working, and, most importantly, its actual work. This essay describes the Council's mission, discusses its public ways of working, and reviews the five major works produced during the Council's first term. In all its activities, the Council has sought to develop a richer bioethics, one that recognizes and tries to do justice to the deep issues of our humanity raised by the age of biotechnology. Believing that these issues are properly matters to be discussed and governed by the polity as a whole, the Council also has sought to contribute to a genuinely public or political bioethics, beyond the rule of "experts," scientific and bioethical.     

Respecting difference and moving beyond regulation: tasks for U.S. bioethics commissions in the twenty-first century

This article focuses on two possible missions for a national bioethics commission. The first is handling differences of worldview, political orientation, and discipline. Recent work in political philosophy emphasizes regard for the dignity of difference manifested in "conversation" that seeks understanding rather than agreement. The President's Council on Bioethics gets a mixed review in this area. The second is experimenting with prophetic bioethics. "Prophetic bioethics" is a term coined by Daniel Callahan to describe an alternative to compromise-seeking "regulatory bioethics." It involves a critique of modern medicine. In the contemporary context, the areas of biotechnology and access to health care cry out for prophetic attention. The Council has addressed biotechnology; unfortunately, that experience suggests that the kind of prophecy that it practices poses risks to conversation. With regard to access issues, the article proposes an effort that unites themes of human dignity, solidarity, and limits in support of reform, while highlighting, rather than papering over, differences.     

Reward Preferences of Salespeople: How do Commissions Rate?

Compensation plans, including salary, commissions, incentives, promotion, recognition, and rewards, are critical in motivating and influencing salespeople. While commissions are often considered a key component of companies’ compensation and reward structures, past studies have overlooked commissions when studying salespeople’s relative preferences for rewards. The present study extends Chonko, Tanner, and Weeks’s (1992) research by examining salespeople’s preferences for commissions versus other rewards. The findings of this study support the importance of increases in commissions as a reward for salespeople across different industries and different demographic profiles. Higher commission rates were the most preferred reward, followed by pay raises. Promotion and recognition were the least preferred rewards. Managers can utilize the results of this study as they design compensation plans within their companies.     

Spanning our differences: moral psychology,physician beliefs,and the practice of medicine

Moral pluralism is the norm in contemporary society. Even the best philosophical arguments rarely persuade moral opponents who differ at a foundational level. This has been vividly illustrated in contemporary debates in bioethics surrounding contentious issues such as abortion and euthanasia. It is readily apparent that bioethics discourse lacks an empirical explanation for the broad differences about various topics in bioethics and health policy. In recent years, social and cognitive psychology has generated novel approaches for defining basic differences in moral intuitions generally. We propose that if empirical research using social intuitionist theory explains why people disagree with one another over moral issues, then the results of such research might help people debate their moral differences in a more constructive and civil manner. We illustrate the utility of social intuitionism with data from a national physician survey.     

Bioethics and natural law: the relationship in Catholic teaching.

In the discipline of Catholic moral theology, bioethics (traditionally described as medical ethics) has held a major place. The systematic development of bioethics has drawn principally upon a natural law ethic, supported by broader religious arguments. The purpose of this essay is to examine the status and role of natural law in Catholic teaching as it bears upon bioethics.     

The bioethicist as public intellectual

Public intellectuals have long played a role in American culture, filling the gap between the academic elite and the educated public. According to some commentators, the role of the public intellectual has undergone a steady decline for the past several decades, being replaced by the academic expert. The most notable cause of this decline has been both the growth of the academy in the twentieth century,which has served to concentrate intellectual activity within its confines, and the changing nature of the media, which has framed the way in which information is conveyed to the public. We argue that although bioethics has developed primarily within the academic tradition and utilized the role of expert when dealing with the public, bioethicists are well suited to don the mantle of the public intellectual. Indeed, because they address issues in medicine and science of great relevance for the general public, bioethicists have a duty to revitalize the tradition of public intellectuals as a necessary complement to the important, but narrower role of the expert.     

Addiction,Responsibility and Moral Psychology

Public intellectuals have long played a role in American culture, filling the gap between the academic elite and the educated public. According to some commentators, the role of the public intellectual has undergone a steady decline for the past several decades, being replaced by the academic expert. The most notable cause of this decline has been both the growth of the academy in the twentieth century,which has served to concentrate intellectual activity within its confines, and the changing nature of the media, which has framed the way in which information is conveyed to the public. We argue that although bioethics has developed primarily within the academic tradition and utilized the role of expert when dealing with the public, bioethicists are well suited to don the mantle of the public intellectual. Indeed, because they address issues in medicine and science of great relevance for the general public, bioethicists have a duty to revitalize the tradition of public intellectuals as a necessary complement to the important, but narrower role of expert.     

Bargaining for Truth and Reconciliation in South Africa: A Game-Theoretic Analysis

As regimes move from illiberal to liberal, post-transition justice methodology has been employed to engender truth and reconciliation. These normative concepts have evolved into a policy of creating truth and reconciliation commissions that trade civil and criminal amnesty with applicants in exchange for information. This bargained-for exchange can be analyzed as an imperfect information game, where the commission attempts to maximize information (truth) while the applicant seeks amnesty for the lowest possible price. Using game-theoretic analysis, the authors model the truth-amnesty game and predict the optimal commission strategy. The analysis leads to the recommendation that future transitional justice commissions employ various specific lexicographic ordering strategies to minimize dead weight loss in the transaction.     

Bioethics and Pastoral Concern: Some Possible New Directions in Pastoral Theology

This special issue of the journal is comprised of papers given at a conference in May 2011 at the University of Texas Health Science Center at Houston on the theme of “Social Justice and the Health Professions.” This article offers the following rationale for this special issue in particular and for pastoral theologians to contribute to bioethics in general: (1) two contemporary theological thinkers in bioethics, Karen Lebacqz and Lisa Cahill, argue that theological discussions of justice broaden and deepen discussions of justice in mainstream bioethics—thus the focus on social justice provides an area for interdisciplinary and intersectional work; (2) pastoral theologians have not, to a great extent, contributed to discussions of religion and bioethics—this has been the territory of theological ethicists, especially during the 1970s; (3) one influential pastoral theologian, Bonnie Miller-McLemore, has called for (a) a broader concern for health in pastoral theology beyond psychological health and (b) more disciplinary approaches within pastoral theology beyond psychology so as to attend to “the living human web”; and (4) one way to advance the theological contributions in bioethics is by inviting pastoral theologians to focus on matters of social justice (an established area of intersection) as identified by health professionals, thus providing (a) new areas for inquiry and (b) new theological perspectives in bioethics. This article also suggests that pastoral theologians can contribute to bioethics by focusing on both “macro” issues (issues relating to structures and groups) and “micro” issues (issues relating to persons and experiences) as a way of pursuing the topic of justice in bioethics. The bulk of this article focuses on “macro” issues, but, in closing, the author articulates how he has been addressing “micro” issues in his own work. The author argues that both of these approaches—“macro” and “micro”—are legitimate ways for pastoral theologians to express pastoral concerns in bioethics.     

Survey Article: Justifying the Truth and Reconciliation Commission

Truth commissions have emerged as popular devices for countries which are trying to move from a past of mass human rights violations to a stable and democratic future. South Africa's Truth and Reconciliation Commission (TRC) was by no means the first official commission to inquire into and report on a fraught past, yet it has attracted more interest, including philosophical interest, than any of its predecessors.