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  • Principles and Pragmatism
  • R. Alta Charo (bio)

Openly, privately, or implicitly, every public ethics committee struggles with its mandate. Is its job to identify a moral ideal?; a morally acceptable minimum that, realistically, could be adopted as policy?; or an optimal political compromise that can arguably meet ethical analysis? The answer appears to be different for each committee, depending upon its subject matter, its sponsoring political body, and the details of its legal mandate. What is universal, however, is that even the most well-intentioned committee is likely to experience dissension over the interpretation of its task and that this dissension will often be played out in debates over particular policy recommendations.

Ruth Macklin’s description of disagreement and moral integrity in the context of the Advisory Committee on Human Radiation Experiments demonstrates this phenomenon quite clearly (Macklin 1996). The epistemological debates concerning the evidence of past practices illuminate differing visions of the Committee’s mandate. For some it was to render moral judgment on past acts, without necessarily concluding that, if the acts were immoral, the individuals involved were themselves immoral. For others it was to use moral judgments to determine appropriate forms of restitution, thus balancing the reputational risks to past actors against the need for and feasibility of restitution to the victims. Still others appeared to focus on crafting specific political responses, and the historical data needed only be sufficient to bolster the policy recommendations.

In this respect, the composition of any advisory committee becomes crucial. As fact-finders, committee members must determine the kind of evidence they will find persuasive. This determination, in turn, depends upon whether the committee sees itself primarily as (1) informational, in which case the standards employed by professional historians are probably the most appropriate, or (2) judgmental, in which case something closer to legal standards of proof might be better. The dilemma is not limited to committees looking at history; those rendering advice on science policy need to determine if they will use standards of proof prevalent in the scientific community (consensus following peer review) or the public (scientific consensus coupled with credibility of the scientific community as a whole). [End Page 319]

When a committee is asked to base its judgments on ethical analysis, the conflicts only deepen. The “ethics” of policy recommendations are invariably balanced against the desire to see one’s work yield a concrete political response, the perception of political constraints on implementing an ethically “ideal” solution, and the subtle pressures exerted by the sponsoring political body to respond to the specific committee mandate, which was written with the needs of the sponsoring body in mind, not the needs of a wide-ranging ethics discussion.

Another complication arises because ethics committees derive their credibility from the perception that moral truth is discoverable and unassailable. To horse trade among these moral truths undermines the credibility of their entire endeavor and can render bioethics advisory committees not only ineffective but even offensive. After all, if a moral truth exists, how ethical is it for “ethicists” to abandon it in the name of strategic concerns? If, on the other hand, no moral truth exists, then by what right do these “ethics” committees claim persuasive authority beyond that of any citizen advisory committee?

This is a deep dilemma that relates to the discipline of bioethics itself. Lacking a core methodology or doctrine, bioethics has yet to justify itself to either its proponents or to the public. Bioethics scholars acknowledge that there are a variety of theories drawn from moral philosophy that could be used to guide the resolution of dilemmas that arise in the context of medical care and biomedical research. Such theories include utilitarianism, deontology, teleology, virtue theory, and justice theory, with no one theory being universally adopted by bioethics scholars and no one methodology being available to resolve conflicts among their respective conclusions. While deductivism is the predominant analytical style in the field, “[t]he central difficulty with deductivism is that there is no single comprehensive moral theory, nor even theories or principles of more limited scope, which is agreed to be true or correct” from which defensible conclusions will flow (Brock 1995).

But if public ethics bodies cannot...

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pp. 319-322
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