The Mission and Philosophy of National Bioethics Commissions: Contributing to a Stable Societal Consensus

What do national bioethics commissions do? In a descriptive sense, this is easy to answer—they meet, deliberate, and issue reports. However, this does not answer the question of their mission. That is, what should they try to do when they deliberate and put forth reports? I wish to suggest that a federal bioethics body, whether commission or council, is at its most useful when it contributes to the development of a stable societal consensus on biomedical ethical issues.¹

This thesis requires little direct argumentation for it. After all, who would not like consensus? But, it must be supported by explaining exactly what consensus is and the role consensus plays in our society. In other words, there are two main challenges to acclaiming consensus as the proper goal of a commission's deliberations. First, some may say consensus is not possible. They argue that fundamental value disputes prevent anything resembling a genuine consensus from emerging. To seek consensus is to ask some persons to give up or compromise their important values. According to this objection, reaching consensus requires that some act disingenuously. Second, I must establish the value of consensus through an appropriate characterization of the role it can play in our society. This requires that we characterize consensus not as mere agreement among the members of a federal bioethics body but as a template that may contribute to a stable societal consensus. By showing ways to respect seemingly contrary values, a federal bioethics council may offer a blueprint to assist us in living out our values.

Of course, the President's Council on Bioethics (PCB) appointed by President George W. Bush did not take the production of consensus as its mission.² Those who support the approach of the PCB may argue that an emphasis on consensus is misplaced and a bioethics commission does a better service by giving detailed outlines of all major positions on particular controversies. This mission also has a variety of virtues and there is little doubt that such a commission also may perform a public service. The PCB, in its quest to accurately portray all relevant viewpoints, has included members with views that have historically been artificially dismissed too easily because they are not common among academics. The PCB is also noteworthy for its restoration to prominence of considerations concerning what kind of life our choices regarding technology have fostered and how these choices affect our humanity.³ Such considerations are commonly passed over when seeking consensus because their relative abstractness makes agreement difficult. Nevertheless, when a commission takes the step of putting forward a particular position, one that might advance consensus in our society, it probably contributes something of greater value than if it chooses to refrain from so doing.

Can a Commission Make One from Many?

We are a pluralistic and diverse society. And, such an assertion may very well understate the case. There are moments when it can seem that each individual is his or her own idiosyncratic amalgam of beliefs, values, and judgments. In such a moment, consensus can seem a pipedream. But, as is the case in western industrialized societies, we also have a realm of shared practices in which we live and interact together. For instance, health care is financed and delivered in ways that involve strong public sector support for a traditionally private profession. There is a complex and constant ongoing negotiation about the expectations and standards that the public and the profession have of each other.⁴ While much of the rhetoric surrounding health care sounds individualistic, e.g., the doctor-patient relationship, privacy, and confidentiality, the medical enterprise seems to be generally located within the "commons."⁵ There is no ideological leap in saying that in common, we subsidize medicine, medical education, and health insurance in many ways and for large swaths of our citizenry in order to promote the health of our nation. Thus, we all have a vested interest not only in considering what kind of subsidies and which services promote the general well-being of our people, but also in arriving at solutions...