Grass-roots reflections on substance abuse. A community dialogue approach

The Greater Cleveland Dialogue brings together people from all walks of life to express their sufferings and opinions. Professional ethicists have a role to play in this process, but chiefly as listeners and interpreters rather than as theoreticians. The ethics that arises from this process is at least as useful as the conclusions that descend deductively from the many rival "first principles" of a more theory-driven approach. If community dialogues provide a partial answer to questions of ethics and health care, they do so because they include the public. Policies related to health care affect the public and must be in tune with public sentiment if they are to be effective. Moreover, a different style of health care ethics emerges from the dialogue process. My view is that a truly public bioethics is ultimately necessary, since the policies our society develops in the area of health care can be meaningful only if they are grounded in the general will. We need to work harder at widening the umbrella of bioethics to include the public, for the sake of the community and for our own education as professionals. Certainly major questions for the future surround the nature of consensus and the process of achieving it.