Commission's Deliberations Research Articles

Reimagining Our Public Health Systems: The Robert Wood Johnson Foundation's National Commission to Transform Public Health Data Systems.

Reimagining Our Public Health Systems: The Robert Wood Johnson Foundation's National Commission to Transform Public Health Data Systems.

In Memoriam: David P. Schuyler

In Memoriam: David P. Schuyler

The long shadow of 1927

From an archivist's viewpoint, the 1927 Royal Commission has a particular significance which its participants could hardly have imagined at the time. It coincidentally marked the end of the silent film era, from which the overwhelming majority of productions are now lost, and the beginning of the sound era, from which the survival rate is far better. Most of the films mentioned in the Commission's deliberations, therefore, can no longer be viewed. Despite their hopes, the Commission's work would not advance the fortunes of so many of the significant industry figures who gave evidence and placed their hopes in it. Instead they would soon, effectively, disappear from the scene as the ‘talkie’ era took over. Australia's biggest silent epic, For the Term of His Natural Life, was released in 1927. The creation and the fate of this mammoth production, directed by American Norman Dawn, is in many ways a metaphor for the Commission's deliberations and ultimate outcome: the cultural cringe which accompanied the eclipse of Australian talent by overseas practitioners, the slow contraction of Australian production, and the destruction of its silent heritage. The realities of film survival and preservation are discussed, and the fortuitous recovery and reconstruction of Term for a contemporary audience is traced. Ironically its re-emergence serves to highlight what has been lost. This is an archivist's reflection on the long shadow of 1927.

Independent Commissions as Settings for Civil–Military Deliberation

US combat operations involving women and revelations of sexual abuse in the US military have periodically sparked intense political debates about women’s military roles. In the midst of these debates, US policy makers have repeatedly created independent advisory commissions on issues concerning women in the military. This article uses qualitative case studies of three such commissions to evaluate whether commissions can foster meaningful civil–military dialogue on contentious matters involving the military and society. This article finds that commission deliberations have sometimes led military professionals to change their views of sensitive issues, but that commissioners have been less open to deliberation if they have been affiliated with an organization possessing a distinct political agenda on women in the military. More broadly, the findings suggest that independent advisory bodies can provide valuable mechanisms for civil–military dialogue, so long as policy makers appoint to them individuals who are relatively open minded and unconstrained by political commitments.

The historical foundations of the research-practice distinction in bioethics

The distinction between clinical research and clinical practice directs how we partition medicine and biomedical science. Reasons for a sharp distinction date historically to the work of the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, especially to its analysis of the "boundaries" between research and practice in the Belmont Report (1978). Belmont presents a segregation model of the research-practice distinction, according to which research and practice form conceptually exclusive sets of activities and interventions. This model is still the standard in federal regulations today. However, the Commission's deliberations and conclusions about the boundaries are more complicated, nuanced, and instructive than has generally been appreciated. The National Commission did not conclude that practice needs no oversight comparable to the regulation of research. It debated the matter and inclined to the view that the oversight of practice needed to be upgraded, though the Commission stopped short of proposing new regulations for its oversight, largely for prudential political reasons.

The Limits of Autonomy: The Belmont Report and the History of Childhood

This article examines the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research recommendations on children as research subjects in the context of the history of American childhood. The Commission's deliberations took place during the post-World War II period of rapid changes in understandings of childhood and adolescence, brought on in part by school children's highly visible roles as risk-taking protagonists in the polio vaccine trials and the civil rights movement; by the children's rights movement and court decisions granting children and adolescents greater autonomy in divorce cases and in delinquency and mental health hearings, among other rights; and finally by a renewed movement for child protection led by parents of disabled children and by polio survivors themselves. The National Commission's final recommendations emphasized the need for parents to approve, for children above age seven to assent to research, and for children in special care (either medical, psychiatric, or because they were orphans or had committed juvenile crimes) generally to be subjects of research only if there was some direct connection between the reasons for their special care and the objectives of the research. Ultimately, in these recommendations, the National Commission charted a middle ground between the children's rights movement, which advocated enhanced self-determination for children, and the disability rights movement, which urged greater protection for children.

Mission Possible: National Bioethics Commissions Beyond the Conservative/Liberal Divide

Mission Possible:National Bioethics Commissions Beyond the Conservative/Liberal Divide F. Daniel Davis (bio) What's a National Bioethics Commission to Do? Beyond the Conservative/Liberal Divide In June 2009, President Obama dissolved his predecessor's President's Council on Bioethics (PCBE), announced the formation of a new President's Commission for the Study of Bioethical Issues (PCSBI), and spurred another round in an ongoing debate about the mission or mandate of a national bioethics commission, its methods, and the criteria by which its work should be judged. Given the contemporary climate for political and moral discourse in this country, one should not be too surprised that this once civil debate has become less so, diminished rather than enriched by sound-bite caricatures of the opposing sides and needlessly pitched between polar positions, one staked out and defended by conservatives and the other by liberals. This is an essay, an attempt, to develop a position beyond the conservative/liberal divide. In simplified form, the conservative position is that a commission's mandate is to deliberate about fundamental philosophical questions generated by advances in biotechnology and by evolving practices in health care and biomedical research—questions about the ends of human life, human dignity and human flourishing. Shunning consensus as a goal, a commission should seek instead to elucidate the differing, often conflicting views of these ends and thereby enlighten the public and policymakers. The liberal position is that a commission's mission is to deliberate on bioethical questions with the eminently practical aim of achieving a consensus, thereby modeling the processes by which citizens in a liberal pluralistic democracy can and should deliberate together on these same questions. And, through the attainment of consensus, a commission should provide an ethically secure, politically legitimate basis for public policy. Within the constraints of this either/or of seemingly irreconcilable positions, one is either for or against consensus. One is either for or against deliberation on fundamentally philosophical questions. One is either for or against the claim that a commission should contribute to the practical process of ethically enlightened policy making. In this essay, I attempt to defend a third position, unfettered by these constraints. From the perspective that informs my attempt, the dichotomy of conservative and liberal standpoints on the question of a commission's proper mandate appears false and over-determined—over-determined, that is, by the polarized character of contemporary political discourse and by the often strident controversy that surrounded the PCBE, generating critics and defenders who give no quarter to their opposition. As for the substance of my position, it is informed by scholarly engagement with the theory and history of public bioethics and by personal experience, for I served, from January 2006 to September 2009, as PCBE's executive director. I set out from the basic observation that in the U.S., bioethics commissions have been, and should continue to be responsive to different needs—needs of the public and policymakers and for ethical advice. A commission can provide that advice in different forms, depending upon the specific need. The specific need determines the form of the advice rendered as well as the method and goal of a commission's deliberations. Thus, a commission should not be restricted to a particular process or goal and should, instead, have the flexibility to adapt these to the specific need for the advice it is called upon to give. Despite the rhetoric of today's debate, this sort of flexibility is observable in the actual practices of recent bioethics commissions, including the PCBE. My position, however, imposes three necessary conditions on the rendering of that advice by a bioethics commission. First, in deliberating with the aim of providing the needed advice, even if the need is for "practical policy options," a commission must reckon with philosophical fundamentals, with ends as well as means, with often conflicting visions of what is good, right, and just.1 Second, the advice rendered should be responsive to a need explicitly identified and articulated by the President (or by his surrogates in the executive branch). The executive order that established PCBE and the more recent order creating PCSBI contain nearly identical second sections stating that the...

Predicting Wetland Plant Community Responses to Proposed Water-level-regulation Plans for Lake Ontario: GIS-based Modeling

Integrated, GIS-based, wetland predictive models were constructed to assist in predicting the responses of wetland plant communities to proposed new water-level regulation plans for Lake Ontario. The modeling exercise consisted of four major components: 1) building individual site wetland geometric models; 2) constructing generalized wetland geometric models representing specific types of wetlands (rectangle model for drowned river mouth wetlands, half ring model for open embayment wetlands, half ellipse model for protected embayment wetlands, and ellipse model for barrier beach wetlands); 3) assigning wetland plant profiles to the generalized wetland geometric models that identify associations between past flooding / dewatering events and the regulated water-level changes of a proposed water-level-regulation plan; and 4) predicting relevant proportions of wetland plant communities and the time durations during which they would be affected under proposed regulation plans. Based on this conceptual foundation, the predictive models were constructed using bathymetric and topographic wetland models and technical procedures operating on the platform of ArcGIS. An example of the model processes and outputs for the drowned river mouth wetland model using a test regulation plan illustrates the four components and, when compared against other test regulation plans, provided results that met ecological expectations. The model results were also compared to independent data collected by photointerpretation. Although data collections were not directly comparable, the predicted extent of meadow marsh in years in which photographs were taken was significantly correlated with extent of mapped meadow marsh in all but barrier beach wetlands. The predictive model for wetland plant communities provided valuable input into International Joint Commission deliberations on new regulation plans and was also incorporated into faunal predictive models used for that purpose.

The US National Bioethics Advisory Commission as a boundary organization

Public bioethics advisory bodies have been a staple of US public policy for addressing public biotechnology- related controversies, in spite of the limited impact these bodies have had on policy-making. These advisory bodies serve an important tacit function as boundary organizations that stabilize the border between science and politics, preserving the autonomy of science from incursion by other societal stakeholders. In this paper the boundary work of the US National Bioethics Advisory Commission is examined at the border of science and ethics, in its deliberations on embryonic stem cell research. The coupling of scientific and ethical uncertainty, and that of research productivity and integrity assurance in the Commission's deliberations is described. It is argued that the Commission's boundary work reinforced the authority of science and marginalized conflicting civic-sector concerns. Copyright , Beech Tree Publishing.

Public policy and mental illnesses: Jimmy Carter's Presidential Commission on Mental Health.

President Jimmy Carter's Presidential Commission on Mental Health was intended to recommend policies to overcome obvious deficiencies in the mental health system. Bureaucratic rivalries within and between governments; tensions and rivalries within the mental health professions; identity and interest group politics; the difficulties of distinguishing the respective etiological roles of such elements as poverty, racism, stigmatization, and unemployment; and an illusory faith in prevention all influenced the commission's deliberations and subsequent enactment of the short-lived Mental Health Systems Act. The commission's work led to the formulation of the influential National Plan for the Chronically Mentally Ill, but a system of care and treatment for persons with serious mental illnesses was never created.

Community-Engaged Scholarship: Is Faculty Work in Communities a True Academic Enterprise?

Since Ernest Boyer's landmark 1990 report, Scholarship Reconsidered: Priorities of the Professoriate, leaders in higher education, including academic medicine, have advocated that faculty members apply their expertise in new and creative ways in partnership with communities. Such community engagement can take many forms, including community-based teaching, research, clinical care, and service. There continues to be a gap, however, between the rhetoric of this idea and the reality of how promotion and tenure actually work in health professions schools. The Commission on Community-Engaged Scholarship in the Health Professions was established in October 2003 with funding from the W.K. Kellogg Foundation to take a leadership role in creating a more supportive culture and reward system for community-engaged faculty in the nation's health professions schools. The authors prepared this article to inform the commission's deliberations and to stimulate discussion among educators in the health professions. The authors define the work that faculty engage in with communities, consider whether all work by faculty in community-based settings is actually scholarship, and propose a framework for documenting and assessing community-engaged scholarship for promotion and tenure decisions. They conclude with recommendations for change in academic health centers and health professions schools.

Human Rights in 2002: The Annual Sessions of the UN Commission on Human Rights and the Economic and Social Council

The fifty-eighth session of the United Nations Commission on Human Rights opened with the United States in an observer seat for the first time ever. The Commission ultimately adopted ninety-two resolutions and eighteen decisions, thirty-nine of which were adopted by roll-call vote. Subsequently, at its July 2002 session, the Economic and Social Council (ECOSOC, the parent body of the Commission) approved nearly all of the Commission's decisions by similar votes. The United States was also reelected to the Commission for its fiftyninth session during a separate ECOSOC meeting.The debate during the Commission's deliberations was more chaotic and fractious than in prior years, reflecting the membership of an increased number of repressive governments that sought to block international scrutiny of their human rights practices.

Consumer Protection in Health Care

This article traces the evolution of the consciousness that has occurred relative to consumer protection and quality in health care, discussing the 1997 Advisory Commission Report on Consumer Protection and Quality in the Health Care Industry. The end result of the commission deliberations was the Consumer Bill of Rights that addresses explicit consumer rights and cover information disclosure and privacy, choice of providers and plans, access to emergency care, participation in treatment decisions, respect and nondiscrimination, confidentiality of health information, and complaints and appeals. Once the bill was finalized, the Clinton administration began actively working to implement the new patient protections. Congressional activity also accelerated and took the form of managed care patient protections and ultimately managed care reform. The author presents and analyzes a number of the bills that have been introduced in the 106th Congress, and provides a summary of legislative activity relative to managed care reform.

The Low Pay Commission in Context

The Low Pay Commission was established in July 1997, and produced its ‘First Report’ in June 1998. It formed part of a series of initiatives marking a new Labour Government in the UK, which included inter alia the White Paper ‘Fairness at Work’, setting out new state positions on union recognition and wide-ranging changes to the benefits system. This article provides an initial comment on this institution, focusing on context, process, and remit, and on relevance to broader debates on the meaning of ‘fair’ wages and economic ‘efficiency’. The first section explores the political economic context. The second compares and contrasts the Commission's deliberations and recommendations. Finally, an assessment is made of these recommendations and the implications for trade unions.

The Low Pay Commission in context

The Low Pay Commission was established in July 1997, and produced its ‘First Report’ in June 1998. It formed part of a series of initiatives marking a new Labour Government in the UK, which included inter alia the White Paper ‘Fairness at Work’, setting out new state positions on union recognition and wide-ranging changes to the benefits system. This article provides an initial comment on this institution, focusing on context, process, and remit, and on relevance to broader debates on the meaning of ‘fair’ wages and economic ‘efficiency’. The first section explores the political economic context. The second compares and contrasts the Commission's deliberations and recommendations. Finally, an assessment is made of these recommendations and the implications for trade unions.

How Much Should Mind Matter? Mens Rea in Theft and Fraud Sentencing

the U.S. Sentencing Commission. The U.S. Sentencing Commission recently voted to publish a proposal in the Federal Register that revises the definition of the primary determinant of sentence length for theft and fraud offenses.1 [Ed. Note: The Commission proposal is reproduced at p.168 of this issue of FSR.] Anyone who has followed the Commission's delibera tions on will see that the proposed definition attempts to address many of the contentious issues that have arisen in the case law and commentary. The issues that the proposed definition concentrates on, however, such as credits, interest, causation, and gain, tend to inform the inquiry into loss rather than even though the latter concept is integral to both definitions. Although neither the current nor the proposed definition provides much guidance for working with intended loss, the Commission did preserve the whichever is greater rule that is currently found in the fraud guideline: if the that the defendant intended is higher than the actual that occurred, use intended as the final figure. It also added a short definition of the term: 'Intended loss' means the [economic] harm intended to be caused by the defendant and other persons for whose conduct the defendant is accountable under ? 1B1.3 [and that realistically could have occurred].2 Unfortunately, both the whichever is greater rule and the proposed intended definition are seriously flawed. As the following discussion will demonstrate, the whichever is greater rule has the effect of treating different defendants similarly, and the proposed definition fails to account for certain mental states that may merit increased punishment even though they do not rise to the level of intent. Correcting these shortcomings would improve the definition and help ensure that federal courts impose properly proportionate sentences.

Back to Basics: Helping the Commission Solve the "Loss" Mess with Old Familiar Tools

Roughly one-quarter of all convicted federal defendants are sentenced for some kind of economic crime.1 There is an emerging consensus that the provisions of the . federal sentencing guidelines devoted to economic crime do not work very well, a consensus that has created a powerful momentum for significant change. This Issue of FSR is about whether the guidelines concerning economic offenses, principally ?2Bi.i (Theft) and 52F1.1 (Fraud), should be materially altered, and if so, how. The debate that has been joined over this question is technically complex and philosophically challenging. There are disagreements over issues as particular as when collateral posted by a defendant in a fraudulent loan transaction should be valued, and as broad as whether actual harm inflicted by crime or the culpable mental state of the criminal should be the most important factor in assessing offense seriousness. Whatever the outcome, the Commission's deliberations in this area promise to be among the most substantive and stimulating in years. My own involvement with economic crime sentencing began as a fraud prosecutor, and continued as Special Counsel to the Sentencing Commission. After leaving the government, my work on the problem culminated in a comprehensive analysis of punishment in theft and fraud cases,2 and a specific proposal for a consolidated theft/fraud guideline incorporat ing a substantial redefinition of the core concept of loss, both of which were presented to the Commission in October 1997. The proposal is reproduced infra at p. 173.

Sex Offender Sentencing in Washington State

prison; the remainder received either a jail sentence or probation. For those who were imprisoned, the average length of stay was just over five years.1 For sex offenders determined by the court to be psychopaths, civil commitment was available. Approximately 200 sex offenders received inpatient treatment at a state mental hospital, which lasted about two years. The hospital staff made continual decisions regarding the offender's progress in treatment. Only about 20 percent of those offenders sent to the hospital were successfully discharged; the remainder were returned to court and sentenced to prison terms.2 In 1981, the Legislature embarked on sentencing reform and appointed a Sentencing Guidelines Commission to recommend the first sentencing guidelines.3 The Commission completed its initial work in 1983. However, at that time the group requested another year to determine if and how to incorporate treatment options for sex offenders. The Commission's report noted that both advocates of sexual assault victims and specialists in the treatment of sex offenders were concerned about the ramifica tions of presumptive sentencing on treatment opportunities for sex offenders.4 Under the indeter minate sentencing scheme, the offender was offered treatment as part of a probation sentence. If the offender did not succeed or failed to cooperate, the court could impose a jail or prison term later. Since determinate sentencing is an up-front system, however, accommodating treatment meant carving out special rules for sex offenses. During 1982, Commission members met with prosecutors, defense attorneys, victim and sex offender treatment professionals and received letters from many citizen groups and individuals. In addition, they reviewed scientific research and contacted national experts in the field of sex offender treatment. In the Commission's deliberations, the victim's response to sex crimes was an important consideration. The Commission learned that many victims and their families want the offender to receive treatment rather than be incarcerated, particularly in cases involving child sexual abuse by relatives. Without the cooperation of victims and their families, the criminal justice system could not effectively respond to sexual abuse. With incarcera tion as the sole options, victims and other family members aware of sexual abuse might not be willing to report the offender. The Commission also considered the offender's incentives to cooperate with treatment. Offenders are usually aware that undergoing treatment, especially if the professional is well-qualified and effective, will not be easy: the inquiry will be very intrusive. By contrast, doing time in jail or prison may be boring, frightening, or oppressive, but the level of intrusive ness will not be nearly so high. Therefore, the Commission saw the need to structure a system with incentives for the offender, since public safety is enhanced when treatment reduces re-offending. Ultimately, the Commission chose to craft a special treatment option for certain sex offenders that allowed them to receive treatment in lieu of incar

Society's choices: social and ethical decision making in biomedicine

Breakthroughs in biomedicine often lead to new life-giving treatments but may also raise troubling, even life-and-death, quandaries. Society's Choices discusses ways for people to handle today's bioethics issues in the context of America's unique history and culture--and from the perspectives of various interest groups. The book explores how Americans have grappled with specific aspects of bioethics through commission deliberations, programs by organizations, and other mechanisms and identifies criteria for evaluating the outcomes of these efforts. The committee offers recommendations on the role of government and professional societies, the function of commissions and institutional review boards, and bioethics in health professional education and research. The volume includes a series of 12 superb background papers on public moral discourse, mechanisms for handling social and ethical dilemmas, and other specific areas of controversy by well-known experts Ronald Bayer, Martin Benjamin, Dan W. Brock, Baruch A. Brody, H. Alta Charo, Lawrence Gostin, Bradford H. Gray, Kathi E. Hanna, Elizabeth Heitman, Thomas Nagel, Steven Shapin, and Charles M. Swezey.

Expressing Corporate Guilt

Corporations and Criminal Responsibility, Celia Wells's important book, is imbued with the conviction that the activities of limited companies inflict too great a cost in terms of injury and death on the workers they employ and the community at large. This concern about what she graphically describes as corporate 'violence'1 is informed by a series of recent disasters, most notably the sinking of the Herald of Free Enterprise at Zeebrugge, an event given continuing resonance by the more recent sinking of The Estonia. These tragedies have given rise to a number of official enquiries and reports which contain significant criticisms of the attitude to safety of a number of commercial companies2 and public authorities.3 In the light of these events, a recent Law Commission consultation paper has recommended the retention of manslaughter by gross negligence and has made proposals to facilitate the conviction of companies for that offence.4 Wells's book is referred to in the Law Commission's deliberations. It is a work of considerable scholarly interest and appears at a time when its subject-matter features prominently as a topic of public concern.