Bioethics on the congressional agenda.

Bioethics on the Congressional Agenda Many people involved with bioethics are aware that the U.S. Congress passed legislation almost three-and-a-half years ago that authorized a standing body to deal with issues in this field, but most of them seem also to believe that nothing came of that legislation. In a way they are right--but may still be proven wrong. To understand why, it helps to look back a few years, to a time even before there was a Hastings Center. Congress has long recognized that developments in biomedical research and in the delivery of health care raise profound and often troubling ethical issues to which it ought to attend in framing public policy on a wide variety of subjects. As early as 1968, then-Senator Walter Mondale introduced a joint resolution to establish a national advisory commission to study "the ethical, social, and legal implications of advances in biomedical research and technology." A history of involvement with bioethical issues has yet to make them easy ones for the Congress to address, however. In 1974, following revelations of various abuses in research with human subjects, Congress adopted the National Research Act. This law not only mandated institutional review boards at facilities that conduct federally funded human subjects research but also established within the then-Department of Health, Education, and Welfare (HEW) a National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. In addition to its responsibilities to report on the principles and process of such research (which it did over the following four years in a series of influential reports), the National Commission was also given an assignment derived from Senator Mondale's proposal: to conduct a "special study" on the implications of biomedical advances. Apparently pleased with the National Commission's work--but also recognizing that the issues beyond research had received the least attention from the commission--Congress authorized a successor body. The President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research was likewise made up of ethicists, lawyers, social scientists, and others in addition to physicians and researchers, but with a broader mandate (toward the practice of medicine as well as research) and a government-wide purview. The National Commission had been quickly appointed and immediately began work on its first report (due three months after it was convened), but more than a year elapsed between the passage of the statute creating the President's Commission in November 1978 and the swearing-in of the Commissioners at the White House in January 1980. From my biased vantage-point (as executive director), the reports of the President's Commission seemed to be well received in Washington, as well as in hospitals and universities across the country, and a proposal was made to extend the "sunset clause" in its enabling legislation for several years beyond the originally specified date of December 31, 1982. Some in Congress thought they would be better served by a body that was closer to the legislative process, fearing that a conservative direction would mark the continued existence of the President's Commission, even though others argued that the Commission (which acted unanimously on all recommendations and conclusions save one) had been "too liberal." Instead of a two-year extension, just three months were added, and the Commission issued the last of its eleven reports and closed its doors on March 31, 1983. Two-and-a-half years later, building on a proposal first made by then-Representative Albert Gore, Jr. to establish a commission specifically on human genetic engineering, Congress included provisions in the Health Research Extension Act of 1985 to create a Biomedical Ethics Board (BEB), made up of six representatives and six senators (evenly divided between the two major parties), and a Biomedical Ethics Advisory Committee (BEAC) comprised of fourteen people from a variety of fields, to be appointed by the BEB. …