August 6, 2008 — One of the special challenges we face in an open, democratic society is the necessity of grappling with complex, often emotionally charged, issues. Should we allow embryonic stem cell research? Is it the right time to withdraw our troops from Iraq? How can we best ensure that our young people leave school well prepared to live full and rewarding lives? In an authoritarian or theocratic state, those in authority simply decide what's best. In a democracy, we have a special opportunity — and even an obligation — to make wise decisions, not merely absolute ones.
There are many ways to do this. One approach is to take received wisdom — religious, philosophical or cultural — and apply it to a particular problem. The other — and the one that James Childress is more interested in — is to develop practical wisdom from a thorough investigation of the problem at hand. This investigation would naturally include religious, philosophical and cultural beliefs among the panoply of relevant facts and perspectives. "Practical wisdom arises through the exercise of judgment," he said. "It is the result of an open, inclusive, knowledge-intensive process of problem-solving."
Childress' own efforts to arrive at recommendations to address the shortage of organs for transplantation illustrate this process. Childress, the University of Virginia's John Allen Hollingsworth Professor of Ethics, directs the Institute for Practical Ethics and Public Life. In 2004, he was asked to chair the Committee on Increasing Rates of Organ Donation for the Institute of Medicine, which, as part of the National Academies, is charged with providing independent, objective advice for policymakers and government officials.
Since organ transplantation was introduced more than 50 years ago, hundreds of thousands of people have had their lives extended and their health enhanced. Unfortunately, the supply of organs has not kept up with the demand. In the United States alone, the waiting list now approaches 100,000, while the annual supply is just under 30,000.
One key to achieving practical wisdom is to bring together experts from all the relevant fields. The process benefits not only from their specialized expertise, but also from their different viewpoints. Childress' committee included surgeons, business professors, members of organ transplant boards, as well as organ donors, and they heard testimony from scores of stakeholders. Public participation is crucial. Without public trust in the system, people are less likely to donate organs.
The second step is to master the facts. Childress' committee members had to understand the social, religious and political values that shape our cultural response to organ transplantation. They also had to familiarize themselves with the current transplantation system, identify barriers that limit the supply of organs and consider the available solutions.
Finally, the committee had to develop a series of perspectives and principles to guide its deliberations. These included such issues as respect for an individual's right to govern the disposition of their body and the fairness of whatever policies might be adopted.
At the end of the process, the committee issued a series of recommendations that included maintaining the current system of explicit consent and rejecting the use of financial incentives to increase the supply of organs. In both cases, the committee was careful to limit the application of its conclusions to the present, for, as Childress noted, "as circumstances change, so does practical wisdom."