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Contents vii
A revision of a new textbook is supposed to main- filling out the discussions with background on the
tain the best of the old, judiciously enhance where latest medical, legal, and social developments. The
possible, and prudently add where needed (without main issues include paternalism and patient auton-
raising the price). This third edition of Bioethics omy, truth-telling, confidentiality, informed consent,
does just that. Over the years, the text has been research ethics, clinical trials, abortion, assisted re-
judged by numerous teachers to be exactly suitable production, surrogacy, cloning, genetic testing, gene
to their teaching approach, and the aim of this new therapy, stem cells, euthanasia, physician-assisted
edition is to keep it that way. suicide, and the just allocation of health care.
Bioethics provides in-depth discussions of the Every issues chapter contains seven to ten read-
philosophical, medical, scientific, social, and legal ings, with each selection prefaced by a brief summary.
aspects of controversial bioethical issues and The articles—old standards as well as new ones—
combines this material with a varied collection of reflect the major arguments and latest thinking in
thought-provoking readings. But on this foundation each debate. They present a diversity of perspectives
are laid elements that other texts sometimes forgo: on each topic, with pro and con positions well rep-
resented. In most cases, the relevant court rulings
1. An extensive introduction to ethics, bioethics,
are also included.
moral principles, critical thinking, and moral
reasoning
2. Full coverage of influential moral theories, special features
including criteria and guidelines for evaluat- A two-chapter introduction to bioethics, moral
ing them (the focus is on utilitarianism, reasoning, moral theories, and critical thinking.
Kantian ethics, natural law theory, Rawls’ These chapters are designed not only to introduce
contract theory, virtue ethics, the ethics of the subject matter of bioethics but also to add co-
care, and feminist ethics) herence to subsequent chapter material and to
3. Detailed examinations of the classic cases provide the student with a framework for thinking
that have helped shape debate in major issues critically about issues and cases. Chapter 1 is an in-
4. Collections of current, news-making cases for troduction to basic ethical concepts, the field of
evaluation bioethics, moral principles and judgments, moral
5. Many pedagogical features to engage students reasoning and arguments, the challenges of rela-
and reinforce lessons in the main text tivism, and the relationship between ethics and
6. Writing that strives hard for clarity and con- both religion and the law. Chapter 2 explores moral
cision to convey both the excitement and theory, shows how theories relate to moral princi-
complexity of issues without sacrificing ples and judgments, examines influential theories
accuracy (including virtue ethics, the ethics of care, and
feminist ethics), and demonstrates how they can be
topics and readings applied to moral problems. It also explains how to
Nine chapters cover many of the most controversial evaluate moral theories using plausible criteria of
issues in bioethics, detailing the main arguments and adequacy.
xi
instructor use. Student resources are available on Devin Frank, University of Missouri–Columbia
the companion website at www.oup.com/us/vaughn Kathryn M. Ganske, Shenandoah University
and include self-quizzes, flashcards, and helpful Martin Gunderson, Macalester College
web links. Helen Habermann, University of Arizona
Stephen Hanson, University of Louisville
Karey Harwood, North Carolina State
acknowledgments
University
This edition of the text is measurably better than
Sheila R. Hollander, University of Memphis
the first thanks to the good people at Oxford Uni-
Scott James, University of North Carolina,
versity Press—especially my editor Robert Miller
Wilmington
and assistant editor Alyssa Palazzo—and many
James Joiner, Northern Arizona University
reviewers:
William P. Kabasenche, Washington State
Keith Abney, Polytechnic State University University
at San Luis Obispo Susan Levin, Smith College
Kim Amer, DePaul University Margaret Levvis, Central Connecticut State
Jami L. Anderson, University of Michigan University
Carol Isaacson Barash, Boston University Burden S. Lundgren, Old Dominion University
Deb Bennett-Woods, Regis University Joan McGregor, Arizona State University
Don Berkich, Texas A&M University Tristram McPherson, Virginia Tech
Stephan Blatti, University of Memphis Jonathan K. Miles, Bowling Green State
William Bondeson, University of Missouri, University
Columbia James Lindemann Nelson, Michigan State
Lori Brown, Eastern Michigan University University
David W. Concepción, Ball State University Thomas Nenon, University of Memphis
Catherine Coverston, Brigham Young Laura Newhart, Eastern Kentucky University
University Steve Odmark, Century College
Russell DiSilvestro, Assistant Professor, Assya Pascalev, Howard University
California State University, Sacramento Viorel Pâslaru, University of Dayton
John Doris, Washington University in St. Louis David J. Paul, Western Michigan University
Denise Dudzinski, University of Washington Anthony Preus, Binghamton University
School of Medicine Susan M. Purviance, University of Toledo
Craig Duncan, Ithaca College Sara Schuman, Washtenaw Community College
Anne Edwards, Austin Peay State University David Schwan, Bowling Green State University
John Elia, University of Georgia M. Josephine Snider, University of Florida
Christy Flanagan-Feddon, Regis University Anita Silvers, San Francisco State University
Jacqueline Fox, University of South Carolina Gladys B. White, Georgetown University
School of Law Joseph Wellbank, Northeastern University
Leslie P. Francis, University of Utah David Yount, Mesa Community College
big questions through critical reasoning, logical some or all of these as proper guides for our ac
argument, and careful reflection. Thus ethics— tions and judgments. In normative ethics, we
also known as moral philosophy—is a reasoned ask questions like these: What moral principles,
way of delving into the meaning and import of if any, should inform our moral judgments?
moral concepts and issues and of evaluating the What role should virtues play in our lives? Is the
merits of moral judgments and standards. (As principle of autonomy justified? Are there any
with morality and moral, we may use ethics to exceptions to the moral principle of “do not
say such things as “Kant’s ethics” or may use kill”? How should we resolve conflicts between
ethical or unethical to mean right or wrong, moral norms? Is contractarianism a good moral
good or bad.) Ethics seeks to know whether an theory? Is utilitarianism a better theory?
action is right or wrong, what moral standards A branch that deals with much deeper ethical
should guide our conduct, whether moral prin issues is metaethics. Metaethics is the study of
ciples can be justified, what moral virtues are the meaning and justification of basic moral be
worth cultivating and why, what ultimate ends liefs. In normative ethics we might ask whether
people should pursue in life, whether there are an action is right or whether a person is good,
good reasons for accepting a particular moral but in metaethics we would more likely ask what
theory, and what the meaning is of such notions it means for an action to be right or for a person
as right, wrong, good, and bad. Whenever we try to be good. For example, does right mean has the
to reason carefully about such things, we enter best consequences, or produces the most happi-
the realm of ethics: We do ethics. ness, or commanded by God? It is the business of
Science offers another way to study morality, metaethics to explore these and other equally
and we must carefully distinguish this approach fundamental questions: What, if anything, is
from that of moral philosophy. Descriptive the difference between moral and nonmoral be
ethics is the study of morality using the meth liefs? Are there such things as moral facts? If so,
odology of science. Its purpose is to investigate what sort of things are they, and how can they
the empirical facts of morality—the actual be be known? Can moral statements be true or
liefs, behaviors, and practices that constitute false—or are they just expressions of emotions
people’s moral experience. Those who carry out or attitudes without any truth value? Can moral
these inquiries (usually anthropologists, sociol norms be justified or proven?
ogists, historians, and psychologists) want to The third main branch is applied ethics, the
know, among other things, what moral beliefs a use of moral norms and concepts to resolve
person or group has, what caused the subjects to practical moral issues. Here, the usual challenge
have them, and how the beliefs influence behav is to employ moral principles, theories, argu
ior or social interaction. Very generally, the dif ments, or analyses to try to answer moral ques
ference between ethics and descriptive ethics is tions that confront people every day. Many such
this: In ethics we ask, as Socrates did, How ought questions relate to a particular professional field
we to live? In descriptive ethics we ask, How do such as law, business, or journalism, so we have
we in fact live? specialized subfields of applied ethics like legal
Ethics is a big subject, so we should not be ethics, business ethics, and journalistic ethics.
surprised that it has three main branches, each Probably the largest and most energetic subfield
dealing with more or less separate but related is bioethics.
sets of ethical questions. Normative ethics is the Bioethics is applied ethics focused on health
search for, and justification of, moral standards, care, medical science, and medical technology.
or norms. Most often the standards are moral (Biomedical ethics is often used as a synonym,
principles, rules, virtues, and theories, and the and medical ethics is a related but narrower term
lofty aim of this branch is to establish rationally used most often to refer to ethical problems in
“Well, how has it been?” I asked Berthet, as I gripped his hand. “It
was superb!” he responded. There was a hole in his coat. “Not
touched?” “No, a ball just missed taking me off.” He said it with a
calm which I admired. He concealed from me the fact that he had
breathed the abominable vapors.
After all, it was only a local action on our line. It was not, in the
generally accepted sense, a battle. All of us have seen much greater
since then. However, on account of the gas, this first engagement is
vividly present in our memory, a recollection never to be effaced. It
was an encounter so strange! That foul vapor which enveloped the
earth, which ate its way into the fibre of the clothing we wore,
corroded and withered the leaves on the trees, and changed the
aspect of God’s sane creation into a distorted image of hell, will
remain forever one of the deepest infamies of the Germans. After
contact with this poisoned cloud, nothing retained its original
appearance. The arms were red without being rusty, the color of
uniforms was changed. There were very few of our men suffering
from gun or bayonet wounds, but whole mounds of those who died in
convulsions: poor, twisted dead, who agonized in dying; so
disfigured their own mothers could not have recognized them. Some
of them were wringing their hands, others were swallowing stones,
others seemed to be rammed into the earth like stakes. This was not
war; it was worse. This was not the rain of bullets which pierce the
flesh, or break a skull in passing. This was not the brutal shell, which
bursts to fragments, scatters in a thousand directions and mows
down a group of men as gayly as a child knocks down a house of
cards. This was another matter. It was the very air turned accomplice
of the enemy; blinded eyes, frothing mouth, rotted lungs, a breast on
fire; every effort exerted redoubling the torture; the rescuer struck
down above the man he attempted to save; the officer suffering like
his men; the telephone-operator seized in his shelter, the courier
arrested in his course, all alike smothered and struggling with death.
This was a breath from the depths of hell, this diabolic invention,
which that monster, the German Junker, forced men to choose:
weapon of meanness and treachery, which sets at naught the valor
of both defender and assailant!
VII
RHEIMS
WHEN the life fantastic becomes the life ordinary, when one is at the
centre of prodigious events which unroll more rapidly than the picture
on the screen, and appear in ever-new guise, the astonishing thing
becomes a natural thing; the unheard-of becomes the expected. A
distortion of sensation is produced; the brain registers only that
which surpasses the climax of what has already been experienced;
as on mountain heights, peaks which have been surmounted appear
low, and the climber feels that only those are high which are still
above him.
Thus it became the ordinary thing for Berthet and me, as for our
companions, to live in the extraordinary and the supernatural. We felt
quite at home in it, and moved at our ease in a situation which, for
him at least, would have been untenable a few short months before.
We had become soldiers like the others, eating, when we could, a
meagre and coarse ration; sleeping when it was possible; in constant
danger of death, but avoiding it apparently by instinct. We lived with
no more care than the beasts of the field; with beards long, hands
dirty. We dug in the earth, as did all the rest; we watched at the
parapets with eyes puffed from lack of sleep. Uncouthness grew
upon us, and we appeared, at dawn, in the glacial cold, muffled up in
pieces of cloth and skins of animals; hairy, hideous, and fearsome.
We were on patrol duty one night. Creeping about, we passed the
listening-post and advanced on No Man’s Land. Like savages, we
stalked the enemy for hours, trying to surprise some unknown men:
soldiers like ourselves, who might be lost between the lines; men
anxious like ourselves, and like ourselves afraid of death and
suffering. Then we returned, annoyed to come back without having
bagged a foe; regretful that we had not been able to spill some
man’s blood. However——
“However”—thus we reasoned.
Often, in the evening, when we were free between periods of sentry
duty, we would delay our share of heavy sleep wherein one forgot
all; when one lay stretched like a beast in a stable, on a little straw in
the depth of a retreat, poorly protected from the wind and the shells.
We would walk the hundred paces of the length of the
communication-trench, conversing.
The night enveloped us; the night palpitating with the noise of battle.
We could hear the crack of rifles and the roar of cannon. Sometimes
the flying steel whirled over our heads with its weird whistle. Some
corvées passed, heavily loaded, carrying materials for attack and
defense. Habituated as we were to the sight and sound, oblivious to
the familiar racket, we walked quite tranquilly, in spirit far removed
from our surroundings, expanding our thoughts and confiding our
dreams. All sorts of subjects shared our attention: art, history,
literature, politics, we touched upon them all, commented upon all as
if we had been a hundred leagues away from the war, as if no other
occupation had the least claim upon us. The contrast was so vivid,
the difference so striking, that sometimes we stopped and exclaimed
in amazement at ourselves.
By this time we had no childish vanity in the matter. Our sense of
pride was rather above it. We called no one’s attention to our calm
indifference. No! It was night, we were lost in the shadows, no one
could see us. We were simply relaxing our brains in withdrawing our
thought from the present; in leading it, by means of conversation,
toward the past and the future.
One particular desire which we held in common was frequently
mentioned: we wished to visit Rheims, which was quite near. Our
regiment formed a part of the troops of coverture of the city.
However, we could not enter the town without permission, and this
could not be obtained without good reason. We finally found an
excuse, and the rest was easy.
One morning, armed with our permit, we set out. The expedition was
not without danger. For several months, since we had occupied the
trenches at the north of the city, we had known that the Boches were
obstinately bent upon its destruction. Every day brought its rain of
shells. We could see the flames shoot up, we could see writhing
columns of smoke mount to the heavens. No matter; the visit
tempted us, and the most violent storm of iron and fire would not
have deterred us.
So we went. We prepared our minds, as we thought, for every
possible surprise; we were not prepared for what we were destined
to find. Approaching by the Faubourg Cires, we entered a ruin. We
saw nothing but demolished houses, entire streets swept by machine
fire, gnawed by flames, blackened by smoke. Tottering façades,
holding their equilibrium by a miracle, supported the skeletons of
apartment-buildings, in whose walls blackened shell-holes seemed
like dead eyes opened on a void. Heaps of plaster and stone fallen
from the walls rendered passage difficult and impeded our progress.
Occasionally, an entire section of wall would swing slowly, balance
for an instant, then fall in a cloud of dust. It was a house in its death-
throes.
After passing this scene of desolation, we entered a quarter still
intact, where, to our stupefaction, the city came to life again. There
only a few injuries to buildings were visible. Here and there a shell
had wounded a structure. The general appearance of everything was
quite peaceful. The inhabitants followed the usual routine of life with
apparent serenity. Open shops offered their merchandise. Young
girls came and went smiling. A pastry-cook spread out his tarts and
nougats; a stationer displayed his pencils and office supplies; a
haberdasher’s window was filled with collars and cravats. Nothing
indicated war. People went up and down about their business; old
women gossiped on their door-step, and peddlers cried their wares.
Around the Place Royale, which was absolutely in ruins, cabmen
awaited a fare, stroking the manes of their bony horses, or
discussing the price received for the last trip. In the public gardens
mothers watched their little ones at play, caressing them or scolding
them, as if their entire life were assured, as if no thought of anything
unusual entered their brain.
Was it bravery, indifference, habit? Who knows? We were
dumbfounded. What! In a city crushed by shells, tortured by fire,
subjected to the most barbarous treatment, how was it possible to be
so matter-of-fact? Could the life of the populace continue in its usual
channels, indifferent to danger, removed from fear, calm as in time of
peace?
We must look closer to perceive under the surface the explanation of
the anomaly; everywhere, people seated or standing observed a
patient discipline in using only one side of the street: the one
exposed to the direct shock of the shells. Only a city long exposed to
bombardment could conceive such a mechanical precaution. It is a
protection, because the shell, in falling, bursts; its splinters fly in the
opposite direction to that taken by the projectile.
We soon saw the working out of the principle. Attracted by an open
shop, we made some purchases at our leisure. A sinister shriek
crossed the sky, and a racket followed. “They are bombarding,”
calmly remarked the young woman who served us. She listened. “It
is at the cathedral.” Then she continued, most unconcernedly: “Let
us see! Some braid? It is at the other counter. You get the buttons
here, and the wool and the thread. Is that all you wish? That makes
a franc sixty.”
Another roar, this time nearer. The street was immediately deserted.
So quickly that a stranger could not observe the action, every
passer-by disappeared. Every one went underground, somewhere,
into an open cellar. It happened as naturally and quickly as in
ordinary times when people find shelter from a sudden shower. They
knew that the hour to seek cover had arrived. The shower of steel
would last until evening, and would not cease until a new quarter
was obliterated. It was the turn of one faubourg, therefore the others
would escape this time. Consequently, outside the zone attacked,
existence might continue as usual.
Already the rescue squads were running in the direction of the falling
shells, as resolute and well disciplined as when at drill. Duty called
them. They responded, “Present,” without fear or hesitation: down
there people were dying under the ruins of their homes. The
stretcher-bearers rescued the injured in the midst of the tumult. If
they had been praised for their heroism, they would have resented
the praise as an insult.
When recovered from our first astonishment, Berthet and I set out.
This martyred city, so tragic and so calm, seemed to us superhuman.
We found it beautiful. We felt a desire to weep, to cry out, as we
looked at its reddened walls, its yawning windows and wrecked
roofs. We went about gently, as one walks in a place of suffering and
sorrow. In our rather aimless wandering, reverent as in a sacred
place, we came suddenly in front of the cathedral.
It rose before us like a queen, at the turn of the street. The lofty
façade, stained by fire in shades of gold and blood, lifted its proud
head to the sky. The towers were like two arms stretched imploringly
toward heaven: one reddened by fire, the other clothed by the
centuries in the blue veil which shrouds ancient monuments.
Between them the shattered rose-window seemed to moan
distractedly: a silent sob. That dumb mouth in that fire-reddened face
seemed to cry with such hatred, with such anguish, that we stopped,
gripped by the sight.
It was there that the great Crime had written its name! There, where
France had inscribed the most sacred things of her history; there, by
the cradle of the nation, on the book always open, the assassin had
left his thumb-print; his infamy remained inscribed in each gaping
wound, on each fallen statue. The high towers attested to heaven
the execrable violence. The roof was gone, like the scalp which the
savage tears from the head of his victim. The eyes of God could
search to the flagstones and judge with one glance the foul deed.
Outside the church the Place was gloomy, but sublime. By an effect
of fatality, it had become the dwelling-place of the holy relics driven
from the interior. The tabernacle was no longer in the heart of the
cathedral, but scattered in fragments around it: the choir encircled
the church. Fragments of stained-glass replaced the organ-pipes,
and the wind moaned through the leaden groins, and chanted the
dirge of the sacred spot.
Cathedral! Church thrice holy! The murderer tried to destroy thee: he
has given thee eternal life. He tried to gag and choke thee: but the
voice from thy tortured throat resounds higher and clearer
throughout the world. In his stupidity he believed he could annihilate
thee: instead, he has glorified thee. Cathedral! A song in stone, a
hymn—hymn too ethereal for the human ear to catch; a poem of
beauty and light, which the sodden Boche thought to efface, but
which stands resplendent, a witness of his shame, before humanity
and eternal righteousness. Divine, immortal cathedral! Men have
never created a human prayer more sublime than art thou,
bombarded. The German shell believed it had power to destroy thee.
It has crushed thine arches and broken thy wings. Thou hadst no
need of wings to soar. As a spirit of light thou hast floated above the
city; now thou rulest over the city the war, and France; as a symbol,
thou art resplendent over all the world. Rheims, thou wert the shrine
of France; broken, thou art become her emblem. Thou art no longer
ours alone. Thy majesty rises unshaken, triumphant, a divine
intelligence facing savage cruelty; a barrier touched, but not
destroyed, defying bestiality.
We had no words to express our emotions. We walked about, in
silent exaltation. From its purple shroud, still smoking, the enormous
basilique spoke to us. Great scenes in history were enacted in its
sacred precincts: all the sacred kings, the noble sons of France;
Clovis baptized by St. Remy; Charles VII led by Jeanne d’Arc, whose
bronze image still defies the enemy from the porch of the church;
Charles X, last king anointed in this august place—all, all were there
as restless phantoms; powerful, saintly, silent, looking on. We were
satiated with emotion, bewildered by a hundred beauties: the light
through the broken arches, the fragments of art treasures in the dust
at our feet, the scintillating glass on the flagstones. We went away,
fairly giddy with its impassioned grandeur.
The increased cannonade directed our course. It was impossible to
remain longer. We crossed the forsaken park and made a détour
around the deserted station. Behind us lay a city of silence, but her
martyrdom continued incessantly. Shrill whirrings made the air
quiver. Shells growled above the roofs, leaped the streets, crossed
the squares, threatened, fell and exploded. There was a sudden
crash of collapsing floors and of tumbling masonry. A quarter,
somewhere in the city, was being pounded to dust and débris; an
entire quarter was being hammered out of existence. Clouds of
plaster filled the air; great stones crumbled.
Families were unable to escape. Their homes, which should have
sheltered them, were thrown wide open to the brutal dangers of the
street. The invalid’s bed tottered in the ruins, the baby was thrown
from its cradle. The old man died at the side of the youth, the wife in
the arms of her husband, the child at its mother’s breast. The
criminal extermination, determined upon and planned, was
completing its frightful work, was blotting out a city, was beating to
death a country. The Boche, squatting on the commanding heights,
aimed his guns with ease, made sure of his fire and picked out his
prey. He struck practically without risk to himself, sure to hit a target
in the chaos of roofs, to demolish and to destroy. A town—what an
immense quarry! The shell may fall where it will: it is sure to kill. The
explosion will burst in some window, will cross some bedchamber,
will find some victim. A town is a quarry more easily sighted than a
battery. It is huge, it is immovable, it cannot reply. One can destroy it
without danger to oneself.
Therefore the shells fell unerringly; only the flames and smoke made
reply....
We paid it no further attention.