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Giving voice to the pragmatic majority in New Jersey.

Giving Voice to the Pragmatic Majority in New Jersey

From its inception in 1983, the New Jersey Citizens' Committee on Bio-medical Ethics was motivated by the conviction that citizens are responsible for their society. In particular, they are responsible for the systems of health care that form an integral part of any humane society.

It was, moreover, the Committee's conviction that these systems are much too important to be left to hospitals, physicians, government authorities, or the courts. Citizens have the right and responsibility to insist that their preferences and values inform health care policies governing actual medical treatment and the allocation of medical resources.

On the basis of these assumptions, the Citizens' Committee launched its community health program to clarify the ethical and social issues surrounding the provision of health care in New Jersey. With a better understanding of present health care policies and priorities, the Committee's expectation was that the public would play its legitimate part in formulating policy to design a health care system that works in the best interests of all concerned.

Two steps had to be taken to accomplish this: identifying the ethical, social, and technological issues of primary concern to reveal the competing and complementary interests at play in the present system; and providing a framework within which those interests could be incorporated in a systematic way in the provision of health care. The Citizens' Committee established a statewide educational forum within which New Jerseyans were invited to express their points of view, become better informed, and begin to wrestle with the daunting complexity of the interplay of medicine, ethics, economics, and public policy in a representative and pluralistic democracy.

By highlighting the dilemmas accompanying technological advances and underscoring the possible conflicts of values between patients' needs and limited medical resources, the Committee hoped to advance reasonable procedures for making decisions about what health care is provided, when it is provided, and to whom and for how long. From this, ultimately, the Committee expected to provide a body of information reflecting the public's attitude toward and expectations of modern health care. Since New Jersey is a microcosm of the United States, ethnically, socially, and economically, it would be particularly significant if a reasonable consensus could be developed there on appropriately providing health care to everyone.

The basic assumption on which the Citizens' Committee operated throughout is that laypeople or nonexperts can do two things: come to grips intelligently with the issues; and find some common ground for reasonable agreement even in a pluralistic society. After almost three years of community and professional forums, over three hundred in number, and two professionally conducted public opinion surveys, that assumption was shown to be quite reasonable.

Can this assumption hod true for the development of consensus and policy regarding the allocation of health resources? The Committee's work on patient rights and the care of the dying provide grounds for cautions optimism. On these issues, the debate in the media and the political arena has tended to be dominated by those with strongly held ideological positions. Many ordinary citizens, however, feel that these are false alternatives. The majority of citizens whose voices have been heard through the Citizens' Committee are not ideologues but pragmatists, gravitating toward centrist positions and avoiding the polar extremes. Motivating this majority tendency appears to be people's innate sense of privacy and a determination to exercise as much personal control as reasonably possible.

There was, as a result, one persistent theme running through the data generated by the Committee's surveys and community meetings: an overriding preference to make one's own medical decisions. Even in medical conditions such as a coma where they cannot exercise this level of control directly, respondents wanted members of their immediate family to exercise it on their behalf.

It is as though some kind of unwritten social contract is at play here, with one person's exercise of autonomy conditional upon another's exercise of autonomy. If this is the case, the prospects for workable compromises through legislation and public policy are good. Legislators and public policy makers need not feel intimidated by the vocal extremists who have for too long dominated the public debate over health care issues. If nothing else, the work of the Citizens' Committee in New Jersey shows that there is a centrist majority from which can emerge reasonable solutions to the more contentious issues presently besetting health care, whether ethical, economic, or social. Legislators and policy makers should then recognize that in the hands of the majority the future of health care in the United States, for all its complexity, can be a common ground, not a battle ground.

T. Patrick Hill is director of professional education at Concern for Dying, and is a former staff member of the Citizens' Committee on Biomedical Ethics.
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Title Annotation:Grassroots Bioethics Revisited: Health Care Priorities and Community Values
Author:Hill, T. Patrick
Publication:The Hastings Center Report
Date:Sep 1, 1990
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