The blog of the Presidential Commission for the Study of Bioethical Issues

Exploring Democratic Deliberation

Bioethics Commission member Col. Nelson Michael was interviewed in June by BioEdge, a bioethics news site, about the Commission’s capstone report Bioethics for Every Generation: Deliberation and Education in Health, Science and Technology. In a previous post, we discussed Col. Michael’s discussion of lifelong bioethics education. This post will focus on Col. Michael’s discussion of democratic deliberation, which the Commission recommends in its report.

Democratic deliberation is a method of decision-making that brings diverse voices to the table, and promotes mutual respect and reason-giving in order to identify areas of agreement to facilitate solutions to challenging problems. The goal of reaching consensus on a way forward distinguishes deliberation from debate, which involves participants trying to persuade others that their arguments are correct and more compelling than their fellow participants’ arguments. While participants are encouraged to use facts and reasons to support their various positions during the deliberative process, democratic deliberation is intended to be a mutually respectful process, with all participants entering the deliberation with an open mind and a willingness to consider other perspectives.

Xavier Symons, the BioEdge interviewer, asked Col. Michael about the criticism that democratic deliberation “smother[ed] substantial debate in focus groups and reports,” citing the debates and public deliberation that occurred when the Human Fertilisation and Embryology Authority (HFEA) in the United Kingdom considered the ethical implications of transferring a healthy nucleus from a mother’s egg to a donor egg in order to avoid certain mitochondrial diseases. Col. Michael responded by noting that “the discussions were facilitated using democratic deliberation…this distinguished those conversations from the kind of debates we are more accustomed to. Democratic deliberation is not foolproof—limitations and challenges exist with every method of decision making. However…deliberation has many advantages. It provides a morally and practically defensible way for addressing hyperpartisan gridlock. It also promotes mutual respect rather than fueling the sharp polarization and heightened differences that make consensus and legitimate outcomes nearly impossible in our current context.”

The Bioethics Commission outlined steps that decision-making bodies can take to engage in democratic deliberation. Deliberation begins with an open question, for which there might be numerous possible paths forward. The Commission emphasized that it is preferable to conduct deliberations with enough time to affect policy decisions. For example, when the Commission considered whether testing an anthrax vaccine on children was ethically permissible, it did so at a time when the country was not facing an anthrax attack, which gave the Commission time to consult with experts, reflect on the empirical and moral dimensions, and make reasoned recommendations. However, the luxury of time is not always possible in emergency circumstances. The Commission encouraged public officials to anticipate as much as possible potential ethical challenges that could arise during emergency situations and address these challenges in advance, since deliberation might not be possible in the midst of a crisis. In order to fully consider the implications of the question at hand, deliberation calls for consulting experts and members of the public alike. Stakeholders from all walks of life, whether they are scholars in the field or community members and leaders, have an important perspective to contribute, and it is necessary to consider these varied perspectives to come to a solution. Participants in the deliberation are encouraged to openly discuss their various perspectives. While vigorous discussion can be a part of the deliberative process, participants must use accessible and explicit reasons to support their arguments, and must maintain a mutually respectful environment throughout the process. At the end of deliberation, participants develop a detailed plan of action that emerges from the deliberation, which includes addressing ethical duties towards those who are affected by the plan.

We have produced a series of educational materials related to democratic deliberation. The “Guide to Classroom Deliberation for Students and Teachers” introduces the deliberative process in a manner suitable for classroom environments. The Commission has also produced several deliberative scenarios that can be used as the basis for deliberation around an ethically challenging topic. The Commission has also produced “Five Steps for Effective Deliberation” in conjunction with the report Bioethics for Every Generation.

The Bioethics Commission’s educational materials and reports can be viewed and downloaded for free at www.bioethics.gov. The Bioethics Commission welcomes comments and feedback on its materials at info@bioethics.gov.

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Ethically Sound Episode 3: Anticipate and Communicate

bioethics_twitter-v3-08The third episode of the Bioethics Commission’s podcast series, Ethically Sound is now available. This 10-episode series has been created to bring the diverse body of the Commission’s work to a wide audience. Today’s episode, “Anticipate and Communicate,” focuses on the Commission’s sixth report Anticipate and Communicate: Ethical Management of Incidental and Secondary Findings, which addressed how to ethically manage incidental findings—findings that lie outside the aim of a test or procedure—that arise in clinical, research, and direct-to-consumer contexts.

In the report, the Bioethics Commission analyzed the ethical issues related to incidental findings that could arise in clinical, research, and direct-to-consumer settings. During its public meetings, the Commission heard from individuals who have been affected by incidental findings, including Carol Krucoff, a yoga teacher and journalist. Ms. Krucoff spoke before the Commission about the discovery of her brain tumor, which was an incidental finding that resulted from an MRI taken after she fainted during a marathon. Ms. Krucoff opens this podcast by recounting her experience and sharing how the discovery of her incidental finding affected her life. She notes that “advances in imaging technology have made it increasingly common for healthy, asymptomatic people like me to learn of such a disturbing incidental finding.”

The podcast also features Bioethics Commission Member Dr. Christine Grady, Chief of the Department of Bioethics at the National Institutes of Health Clinical Center, who was interviewed by Hillary Wicai Viers, a former Communications Director with the Commission staff. Dr. Grady explains how her background as a researcher and as a nurse informed her understanding of the ethical challenges that incidental findings pose. Dr. Grady also shares how the diverse perspectives that the Commission members brought to the discussion helped address these ethical challenges in a wide range of contexts. “It was really very beneficial and helpful to hear from people who had received information about incidental findings and had vastly different experiences and perspectives on the matter,” Dr. Grady said in reference to the inclusion of diverse perspectives.

Episode 3: Anticipate and Communicate of Ethically Sound is available on our website, as well as on our SoundCloud, iTunes, and YouTube pages. In addition to this episode, listeners can access the first episode in this series, “Safeguarding Children,” and the second episode, “Ethics and Ebola.” Stay tuned for the fourth episode of Ethically Sound, “Privacy and Progress,” which will be available on October 3, 2016. We welcome comments and feedback at info@bioethics.gov.

 

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Introducing New Deliberative Scenario and Teacher Companion from the Bioethics Commission: “Return of Genetic Research Results”

The Presidential Commission for the Study of Bioethical Issues (Bioethics Commission) has released two new educational materials, “Deliberative Scenario: Return of Genetic Research Results” and “Teacher Companion for Deliberative Scenario: Return of Genetic Research Results.” This new deliberative scenario and teacher companion build on the work of two of the Bioethics Commission’s reports, Anticipate and Communicate: Ethical Management of Incidental and Secondary Findings in the Clinical, Research, and Direct-to-Consumer Contexts (Anticipate and Communicate) and Bioethics for Every Generation: Deliberation and Education in Health, Science, and Technology.

Deliberative Scenario: Return of Genetic Research Results” highlights contemporary ethical questions about incidental and secondary findings that can result from genetic testing.

This scenario, like others the Bioethics Commission has released, presents an outline of ethically challenging situations that can provide students an opportunity to practice deliberation.

The “Teacher Companion for Deliberative Scenario: Return of Genetic Research Results” provides teachers with specific instructions for facilitating deliberations for the scenarios in “Deliberative Scenario: Return of Genetic Research Results.” These new educational materials are designed to facilitate deliberation on bioethical issues that have been addressed by the Bioethics Commission, and provide students and teachers with the means to enhance and enrich interdisciplinary ethics education.

These new educational resources are part of a collection of over 60 educational materials that the Bioethics Commission has developed throughout its tenure to support the integration of bioethics education in many disciplines in traditional and nontraditional educational and professional settings. This collection includes a series of teaching tools for students at various educational levels, including topic-based modules, case studies, deliberative scenarios, videos, webinars, and empirical research resources, that address a variety of ethical issues related to public health emergencies, whole genome sequencing, human subjects research, and more.

All of these resources are available for free download and can be integrated into or adapted for existing science or ethics curricula. All Bioethics Commission educational materials are free and available at www.bioethics.gov/education. The Bioethics Commission encourages feedback on its materials at education@bioethics.gov.

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Ethically Sound Episode 2: Ethics and Ebola

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Since the Bioethics Commission was established through Executive Order in 2009 by President Barack Obama, it has released 10 reports on a variety of ethically challenging topics, including synthetic biology, neuroscience, and whole genome sequencing, among others. The Bioethics Commission is excited to release a new podcast series, Ethically Sound. Each episode features one of the Commission’s reports.  Today’s episode, the second in the series, focuses on the Commission’s report Ethics and Ebola: Public Health Planning and Response, which addresses several ethical challenges, including ethical dimensions of public health preparedness, ethical justification for U.S. engagement in global health response, the use of liberty-restricting public health interventions, and selected research ethics issues, that emerged during the response to the 2014-2016 Ebola epidemic in western Africa.

This podcast focuses on the use of restrictive measures, such as quarantine and travel restrictions. Upon their return from affected regions, some health care workers were subjected to restrictive measures by state governments and local public health agencies. Restrictive meaures are sometimes necessary during an epidemic in order to maintain public safety. However, some of the measures used during the Ebola epidemic were overly restrictive, and were issued by state governments and public health agencies in response to the public fear that accompanied Ebola, rather than on the best available scientific evidence. The Commission addressed the stigma and discrimination that can accompany public health emergencies, which can be exacerbated by the use of restrictive measures, and reviewed the historical use of such measures in response to other epidemics. The Commission recommended that governments and public health agencies use the least restrictive interventions necessary, such that interventions are grounded in the best available scientific evidence, and ensure that both the ethical and evidentiary rationale for these measures is clearly communicated, with particular attention to the needs of those most directly affected.

The podcast opens with Dr. Patricia Henwood, an emergency medicine physician and the co-founder and president of the PURE initiative, which examines the use of point-of-care ultrasounds in regions with limited resources. Dr. Henwood recounts her experience of traveling to Liberia during the Ebola epidemic to provide medical care to over 100 patients before the Commission during the Commission’s 20th public meeting. After her return, Dr. faced unclear guidance about what restrictive measures were necessary. Dr. Henwood decided to limit contact with friends and family members during her 21-day monitoring period so they would not have to undergo unnecessary measures. Of her experiences, Dr. Henwood said she and her colleagues were “often touted as heroes while working in West Africa, [but] felt like pariahs once we were back in the United States.”

The podcast also includes an interview with Commission member Dr. Barbara Atkinson, the Founding Dean of the University of Nevada, Las Vegas School of Medicine. Hillary Wicai Viers, former Communications Director with the Bioethics Commission, conducted this interview. Dr. Atkinson discussed some of the ethical challenges surrounding restrictive measures. Regarding the decisions surrounding the use of restrictive measures, Dr. Atkinson said “the people who were making the decisions at a state level were responding to the fear of the public, [not] the scientific facts. The public was very worried about the lethal nature of this virus, and so they responded in a political way, which was to segregate [health care workers].”

The podcast is available on our website, as well as on our SoundCloud, YouTube and iTunes pages. In addition to this episode, listeners also can access the first episode, “Safeguarding Children.” Listeners can follow the podcast using the hashtag #EthicallySound or following us on twitter @bioethicsgov. Stay tuned for the third episode in our series, “Anticipate and Communicate,” which will be available on September 26, 2016. We welcome comments and feedback at info@bioethics.gov.

 

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Ethically Sound Episode 1: Safeguarding Children

bioethics_twitter-v3-08Since the Bioethics Commission was established via Executive Order by President Obama, the Bioethics Commission has released 10 reports on a variety of ethically challenging topics, and has provided recommendations on topics ranging from synthetic biology to neuroscience to whole genome sequencing. In an effort to share the Bioethics Commission’s work with a wide variety of audiences, we are issuing a new podcast series called Ethically Sound.  Today’s episode, the first in the series, focuses on the Commission’s report Safeguarding Children: Pediatric Medical Countermeasure Research, which addressed the ethically challenging topic of when and how to test pediatric medical countermeasures for possible bioterrorism agents. When and how, for example, should we test an anthrax vaccine, approved for adults, in children?

The Ethically Sound: Safeguarding Children podcast centers around the question: How can we best protect children in the event of a bioterrorism attack? At the time this report was written, a vaccine for anthrax had only been tested in adults, but not in children. The Commission was asked to provide recommendations on how this vaccine could be safely tested in children, and when the vaccine would be ethically permissible to test.

The podcast opens with a narrative from Dr. Suzet McKinney, who is the Executive Director of the Illinois Medical District Commission. Dr. McKinney discusses how her public health training taught her that vaccines were largely beneficial, but the thought of an anthrax vaccine that had not been tested in children was a cause for concern. “If there were an anthrax bioterrorism attack in the US and the government determined a need to immunize children with a vaccine that had not been tested and deemed safe, experience tells me that even the most aggressive and comprehensive efforts to educate parents about the risks and potential benefits will be met with anxiety, fear, protest and apprehension… even I would have difficulty agreeing to an untested anthrax vaccine for my own child in the absence of a real, credible threat of attack.”

Hillary Wicai Viers, a former Communications Director with the Commission, interviewed Commission Member Col. Nelson Michael, the Director of the U.S. Military HIV Research Program at Walter Reed Army Medical Institute of Research. Col. Michael discussed his military background, and how the Commission came together to address a particularly sensitive topic. When asked about the most challenging aspect of this topic, Col. Michael said, “Research with children is ethically different from research with other groups, especially when the research in question promises really no direct prospect of benefit for the participants. This was really the heart of our matter. [While] competent adults can volunteer and give their consent and can accept risks and benefits for doing research, children really can’t do that legally or ethically. [As] a consequence, that really posed lots of dilemmas for us as a deliberate group.”

The podcast is available to interested listeners on our website, on our SoundCloud, and will launch shortly on YouTube and iTunes pages. Listeners can also follow the podcast using the hashtag #EthicallySound or following us on twitter @bioethicsgov. Stay tuned for the second episode on our series, “Ethics and Ebola,” which will be available on September 19. We welcome comments and feedback at info@bioethics.gov.

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Introducing the Bioethics Commission’s New Educational Resource: “Classroom Discussion Guide on Ethics and Incidental Findings”

The Presidential Commission for the Study of Bioethical Issues (Bioethics Commission) has released a new discussion guide titled “Classroom Discussion Guide on Ethics and Incidental Findings.” This guide is designed to facilitate students’ engagement with the ethical issues surrounding incidental and secondary findings. This guide builds on the work of the Bioethics Commission’s report Anticipate and Communicate: Ethical Management of Incidental and Secondary Findings in the Clinical, Research, and Direct-to-Consumer Contexts

This guide introduces students of various levels to the ethical issues related to incidental and secondary findings. The guide provides a set of discussion questions to help students understand, evaluate, and reflect on these ethical challenges. The guide also includes three case studies that demonstrate the real-life impact that incidental and secondary findings have had in clinical, research, and direct-to-consumer settings.

This guide is part of a series of classroom discussion guides that have been developed for students at various educational levels, and includes discussion guides on ethical issues related to public health emergencies and neuroscience. We have also developed a series of teaching tools, including topic-based modules, case studies, deliberative scenarios, and empirical research resources. All resources are available for free download, and can be integrated into existing science or ethics curricula, or used to create a new course.

Please stay tuned for forthcoming educational materials, including a new deliberative scenario and teacher companion about incidental findings.

All Bioethics Commission educational materials are free and available at www.bioethics.gov/education. The Bioethics Commission encourages feedback on its materials at education@bioethics.gov.

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Introducing Ethically Sound: A Podcast Series from the Bioethics Commission

bioethics_twitter-v3-08Since the Bioethics Commission was established via Executive Order by President Obama, the Bioethics Commission has put forth 10 reports on a variety of ethically challenging topics, and has provided recommendations on topics ranging from synthetic biology to neuroscience to whole genome sequencing. As the Bioethics Commission’s tenure comes to a close, we are issuing a new podcast series called Ethically Sound.  Beginning Monday, we will release one podcast per week for ten weeks, beginning with the podcast on the report Safeguarding Children: Pediatric Medical Countermeasure Research.

The podcasts focus on a particularly salient ethical challenge that was addressed in each report, and illustrate how these ethical challenges impact our communities and how the Commission’s work can influence how these challenges are handled. Each of the 10 podcasts will open with an introductory vignette from a speaker closely associated with the topic, who will recount his or her personal or professional experiences and thoughts about that ethical challenge. The podcasts will also feature an interview with one of our Commission members, who will recount how the Commission addressed these ethical issues and what challenges they faced along the way.

All of our podcasts are hosted and narrated by the Commission’s former Communications Director Hillary Wicai Viers. Listeners will be able to access the podcast directly on our website, as well as through the Bioethics Commission’s SoundCloud page and iTunes page. Listeners can also follow the podcast using the hashtag #EthicallySound or following us on twitter @bioethicsgov.

The podcast series is our most recent project aimed at bringing the Commission’s work to a variety of audiences. Other available materials include educational modules that can be adopted for classrooms at all levels, by professionals, and by interested individuals. The Bioethics Commission’s reports can be downloaded for free at www.bioethics.gov/studies, and the Commission’s educational materials can be accessed and downloaded for free at www.bioethics.gov/education. We welcome your feedback and comments at info@bioethics.gov.

The first podcast, featuring Dr. Suzet McKinney, Executive Director of the Illinois Medical District Commission and Commission Member Col. Nelson Michael, will be available on September 12 at www.bioethics.gov.

You can listen to the podcasts from our website, and from our SoundCloud,  YouTube and iTunes pages. Listeners can also follow the podcast using the hashtag #EthicallySound or following us on twitter @bioethicsgov.

 

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Bioethics Commission Closes Meeting with Roundtable Discussion

This afternoon, the Presidential Commission for the Study of Bioethical Issues (Bioethics Commission) closed its meeting with a roundtable discussion of the impact of bioethics advisory bodies past, present, and future.

Amy Gutmann, Ph.D., Chair of the Bioethics Commission, asked each panelist to identify one important idea or action that encapsulated their thoughts for the day.

Highlights from the discussion include:

Jonathan Montgomery, LL.M., HonFRCPCH, Chair, Nuffield Council on Bioethics, focused on curating topics so as not to reiterate too heavily what past commissions have already discussed.

Eugenijus Gefenas, M.D., Ph.D., Chairperson, Bureau of the Intergovernmental Bioethics Committee, UNESCO, observed that continuity of name and staff of commissions would improve continuity, even across administrations.

Rebecca Dresser, J.D., Daniel Noyes Kirby Professor of Law, Washington University in St Louis, said: “Get out of the bioethics bubble.” She emphasized the experience and knowledge necessary for well-rounded composition of commissions.

Harold T. Shapiro, Ph.D, President Emeritus, Professor of Economics and Public Affairs, Princeton University, said that external review is necessary for quality work product.

Ruth Macklin, Ph.D., Distinguished University Professor Emerita at the Albert Einstein College of Medicine, urged diversity of membership and the importance of including a variety of perspectives.

Robert Cook-Deegan, M.D., Professor, School for the Future of Innovation in Society, Arizona State University, suggested the importance of using relevant expertise to deliberate.

Alexander M. Capron, L.L.B., Scott H. Bice Chair in Healthcare Law, University of Southern California, said “bioethics is a field of inquiry,” and emphasized that individuals should bring their own knowledge and experience from their disciplines to the table.

Thomas H. Murray, Ph.D., President Emeritus, The Hastings Center, said that commissions should “develop robust communication strategies for key audiences,” emphasizing the important role that commissions play in outreach and education.

Members and panelists then engaged in a discussion about what topics will be relevant for a future commission to take up, how they should deliberate, and what their role in society and politics should be. Check out www.bioethics.gov in the next few weeks to watch the archived webcast or read the transcripts.

Thanks for joining us today.

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Presenters’ Additional Reflections on Bioethics Advisory Bodies

Presenters at today’s Bioethics Commission meeting continued their discussion on the impact of bioethics advisory bodies. Future efforts in bioethics and health policy can take into account lessons learned from the experiences of advisory bodies before them.

In the third session of the day, the Bioethics Commission heard from a variety of speakers considering the past, present, and future impact of such groups. Presenters included Ruth Macklin, Distinguished University Professor Emerita in the Department of Epidemiology and Population Health at the Albert Einstein College of Medicine and Harold T. Shapiro, President Emeritus and current Professor of Economics and Public Affairs at Princeton University. In addition, the commission heard from Rebecca Dresser, Daniel Noyes Kirby Professor of Law at Washington University in St Louis, and Eugenijus Gefenas, Chairperson, Bureau of the Intergovernmental Bioethics Committee for the United Nations Educational, Scientific and Cultural Organization (UNESCO).

Ruth Macklin previously presented before the Bioethics Commission during Meeting 6 on the topic of international research ethics. Today, she spoke of her time on the Advisory Committee on Human Radiation Experiments (ACHRE) (1994-1995) under President Clinton. She also spoke about her membership as a staff consultant on NBAC, and the challenges of writing reports while commission members were changing their minds about recommendations. She spoke about maintain intellectual and moral integrity, when writing on behalf of others’ views.

Harold T. Shapiro drew from his time as Chair on the National Bioethics Advisory Commission under President Clinton (1995-2001) and as a member of the Council of Advisors on Science and Technology under President George W. Bush. He noted that we need to be specific about what bioethics is, what topics are important, and what kind of experts are needed to deliberate. He emphasized that whatever structure a bioethics commission takes, the important factor is that the leadership has access to people who can make change.

Rebecca Dresser previously spoke before the Bioethics Commission during Meeting 17 regarding ethical and societal implications of neuroscience, commenting on research protections for participants who might have impaired consent capacity. Today, she considered her time on the President’s Council on Bioethics under President George W. Bush, offering her own insights about what can happen when bioethics is conducted in the national spotlight, especially when the debates have partisan political aspects. She learned that people of different views can engage in civil debate, despite diverse backgrounds and moral commitments. “Deliberation in bioethics should expand to include the voices of as many possible of those now excluded,” she said.

Eugenijus Gefenas reflected on his experience on UNESCO’s Intergovernmental Bioethics Advisory Committee. He observed “Europe is a good example of capacity building for bioethics committees,” because the countries are different in terms of economics and size. He described some challenges that national bioethics advisory bodies face, including the difficulty of directly implementing recommendations and of measuring impact.

Next up: a roundtable discussion with all of our presenters from today’s meeting. Stay tuned!

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Presenters Reflect on National Bioethics Advisory Bodies

In the second session of the day, the Presidential Commission for the Study of Bioethical Issues (Bioethics Commission) heard from a series of speakers reflecting on the past, present, and future impact of national bioethics advisory bodies. Presenters included Robert Cook-Deegan, Professor at the School for the Future of Innovation in Society at Arizona State University; Alexander M. Capron, Scott H. Bice Chair in Healthcare, Law, Policy and Ethics; Thomas H. Murray, President Emeritus of the Hastings Center; and Jonathan Montgomery, Chair of the Nuffield Council on Bioethics.

Robert Cook-Deegan served on as a member of the Biomedical Ethical Advisory Committee (1987-1990). He observed that the position of the Biomedical Ethical Advisory Committee in Congress as opposed to the executive branch might have contributed to its failure. He noted that an important goal of bioethics commissions should be political impact—for example, the President’s Commission in its Defining Death report influenced state laws. “If a Commission is sanctioned by the US government…there should be something that connects it to the political apparatus, there should be something that you’re doing that matters.”

Alexander M. Capron previously spoke before the Bioethics Commission in 2010 during Meeting 2 regarding the oversight of emerging technologies. Today, he reflected on his time on Chair of the Biomedical Ethics Advisory Committee (1987-1990), and as a member of the National Bioethics Advisory Commission (1995-2001). He emphasized that our Commission has set a good example, showing the ways in which ethical issues move from the research stage to the impact in clinical practice and society. He also noted that topics in public health ethics deserve further examination by bioethics bodies.

Thomas H. Murray, who presented before the Bioethics Commission during Meetings 3 (on emerging technologies), 14 (on integrating ethics throughout the research process), and 21 (in memoriam of John Arras), recalled his time as a member of the National Bioethics Advisory Council (NBAC). He noted the importance of a diversity of perspectives, including ideological and religious variation. He also stated: “Our reports influenced how IRBs, regulators, and researchers think about a variety of issues,” emphasizing the impact that bioethics commissions can have on shaping the debate for generations to come. He complimented our Commission on thoughtful work and excellent use of democratic deliberation to address complex issues.

Jonathan Montgomery previously presented before the Bioethics Commission during Meeting 15 on the Nuffield Council’s efforts to address the social implications of novel advances in neuroscience as the commission deliberated about the ethical and social implications of the President’s BRAIN Initiative prior to releasing its report Gray Matters. At today’s meeting, he discussed his experience on the Nuffield Council of Bioethics in the United Kingdom. He emphasized that Nuffield is not beholden to anyone in terms of the topics they select, which affords them more freedom to explore controversial issues. “It’s crucial that we are courageous,” he said. Respecting the public’s opinion does not mean accepting it without scrutiny.

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This is a space for the members and staff of the Presidential Commission for the Study of Bioethical Issues to communicate with the public about the work of the commission and to discuss important issues in bioethics.

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