On the National Commission: A Puritan Critique of Consensus Ethics

he Report and Recommendations of the National Commission for the Protection of Human Subjects on research involving the institutionalized mentally infirm is an extraordinary example of the development of public ethics. Prudent and helpful as its recommendations are, perhaps more significant is the social institution of ethical deliberation and policy-making that the Commission has created in producing this and its many other reports. The present report presents a general consensus about the moral conflicts involved in doing research on people institutionalized as mentally infirm-a consensus that is adequate for recommending sane, cautious policies with a broad base of support. The Commission has done what it was asked to do. Although I believe that is the proper way of establishing national policy, we must recognize the degree to which this form of deliberation and policy-making exerts a conservative force in choosing among a variety of ethical options. Precisely when the underlying value assumptions of our society cry out for reconsideration, social institutions such as the commission reinforce those assumptions by rationalizing, coordinating, and making them practically applicable.