Introduction

National bioethics commissions have been established over the past 30 years for a variety of overlapping purposes—to call attention to a controversial topic; to clarify the issues at stake; to present ethical arguments for and against certain options; and to offer recommendations regarding governmental, organizational, and professional policies. Their basic goals have been to assist the president, policy makers, and the public in understanding the ethical and social implications of modern biomedical science and practices and to present them with options for policy development. Perhaps the most important contribution of these commissions has been to draw current thinking together to reach conclusions that reflect significant values that citizens believe are at the core of our democratic framework.

Analyses of the work of these commissions that have appeared over the years have addressed such matters as the rationale for their composition and membership; the ethical and policy arguments they have forged; their methodology; the impact of political winds on their work; and how they have been received—or ignored—by the president, Congress, and the public. In this issue of the Kennedy Institute of Ethics Journal, several authors contribute to that growing literature by focusing on the roles and methods of moral reasoning employed by national bioethics commissions with special reference to the work of the President's Council on Bioethics.

The issue begins with a definitive and spirited defense of the work of the Council by its chair, Leon Kass. He delineates the scope of the Council's activities and sets out its basic approach, correcting some misimpressions he finds have arisen about its goals and methods along the way. Kass maintains that the Council, in its first five reports, has sought to move from the narrow sort of reasoning that currently pervades bioethics about such issues as informed consent and the equal treatment of persons toward a richer, broader mode of reflection that offers practical wisdom for those grappling with questions about birth and death, sickness and health, sex and procreation, freedom and dignity. A major thrust of the Council's reports, he explains, is to restore to public bioethics the sort of deep concerns about novel scientific endeavors that originally gave rise to the field.

Public bioethics commissions are assumed to have the responsibility of moving from widely accepted premises to conclusions that will resolve difficult controversies. Yet, James Lindemann Nelson maintains, they must face questions about the theoretical infirmities of morality and the realities of political alienation and moral dissent. He finds that the United Kingdom's Warnock Commission succeeded in addressing such questions, using a Humean "sentimentalist" conception of ethics to reach shared moral understandings against a social context comfortable with compromise and solidarity. In contrast, the President's Council, in its reproductive cloning report, tries to refashion public bioethical discourse in a way that draws on a heterogeneous set of moral ideas that, in the end, are left undefended.

Cynthia B. Cohen elicits the methods of public deliberation about morally contentious issues adopted by the National Bioethics Advisory Commission (NBAC) in its stem cell report and the President's Council in its stem cell and research cloning reports. NBAC sought to discern shared values that cohere with a Rawlsian sort of "public reason" held by those with opposing visions. The President's Council, expressing a Straussian disdain for such an approach, which it maintains can lead only to compromise and relativism, ironically, adopted a remarkably similar method when unable to agree about research cloning policy. Cohen draws from this analysis the seeds of a theory of public deliberation that seeks common ground among conflicting views without debunking differences in understandings.

Mary Anderlik Majumder proposes two additional roles for national bioethics commissions to adopt as they develop ethical and policy conclusions. The first involves engaging in "conversation" that recognizes what Jonathan Sacks has termed "the dignity of difference;" this requires bioethics commissions to seek mutual understanding, rather than agreement. The second, which Daniel Callahan has labeled "prophetic bioethics," calls for a critical review of the current endeavors of biomedicine in order to provide an antidote to complacency and injustice. Majumder goes on to critique Beyond Therapy, the President's Council report...