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This chapter begins with the question ‘What is ethics?’ It is not just a list of prohibitions, but rather a reflection on what we consider to be good or bad. It involves an evaluative and disciplined study of what we regard as morally good and what we see as morally bad. This is required if we are to decide how to act. Moral judgements, it will be shown in this chapter, are not simply based on what we think, but on ethical theories. There are two kinds of ethical theories: meta-ethical theories and normative ethical theories. The former are about the kinds of ways in which we can think about the nature of ethical principles and judgements, such as whether they are conventional or universal. Normative ethical theories provide a framework of moral principles that can help us decide whether or not an action is morally right.
Introduction: What is ethics?
Ethics, as it is commonly understood, is connected with various bans against wrong-doing – particularly in business or in the professions. In people’s private lives, it is seen as demanding that, as far as possible, the actions someone chooses to perform have minimal effect on others around them – in some sense, that what people do is morally right. According to such a view, ethics is a means of regulating human behaviour, and so acts as a constraint on human action. This is, in fact, a very simplistic understanding of ethics. Ethics is not about any of the following:
prohibitions concerned with sex
ideal systems, such as codes of behaviour, which are all very noble in theory, but no good in practice
something intelligible only in the context of religion, or
personal likes and dislikes.
In other words, it is neither relative to a particular time, culture or place, nor is it merely the expression of subjective wants and desires (Singer, 2011).
One the most vexed questions in healthcare involves patient autonomy, and the extent to which patients are able to make decisions about their healthcare. It may not always be the case that patients will be able to understand the information that they have been given and decide what advice regarding their treatment they should follow. The question of autonomy and the extent to which patients are able to give informed consent to the treatment being recommended to them becomes more difficult as their health deteriorates. These issues will be explored in this chapter.
The idea that patients need to be asked to consent to the medical and healthcare treatment that is being proposed to them is reasonably modern. After all, the healthcare practitioner is the professional, the person with the expertise to decide what treatments are needed by the patient in order to return to health. If a patient needs an operation to remove a tumour, they are expected to accept the surgeon’s advice and have the operation. The Hippocratic Oath states nothing about asking patients for their informed consent before the physician prescribes medication or performs surgery. Despite this, it has generally become accepted that, because patients are autonomous, self-determining human persons, they need to be fully informed of the treatment options available to them, and to decide, having assessed the available information and taken appropriate advice, what treatments they will undertake. This is the recognition that a pathway to health will involve the active participation of patients – that is, it is not simply a matter of patients passively receiving treatment. The whole person needs to be involved in recovery to full health.
The transplantation of tissues and organs from deceased donors is well established in Australia, beginning with the first corneal transplant in 1941 and the first kidney transplants in the early 1960s (NHMRC, 2007). In 2013, a total of 391 deceased organ donors gave 1122 Australians a new chance in life after they received an organ transplant (Donate Life, 2014). Transplantation medicine is clearly one of the most dramatic success stories of modern medicine. It is, however, also one of the most ethically controversial, with significant personal, interpersonal and societal dimensions to consider. The practice of donation after death is a source of many of these controversies, especially when the demand for organs far exceeds their supply: around 1500 people are on Australian organ transplant waiting lists at any one time (Donate Life, 2014).
Transplantation medicine has always been guided by the primary ethical requirement that patients must be declared dead before any vital organs can be procured. However, the definition of death is not as straightforward as it once seemed. Whereas patients were once understood to be dead when they ceased to have evidence of circulation, respiration and brain functioning, with the loss of any one of these functions leading to the loss of the other two over a short period of time, the development of modern intensive-care medicine now allows the continuation of circulation and respiration in the absence of detectable brain function. This has made the question ‘When is a person dead?’ far more complicated (Truog & Robinson, 2003) and the ethical and legal requirements for organ donation far more controversial. This chapter critically examines the clinical and philosophical basis for the determination of death by neurological criteria (‘brain death’) and provides ethical analysis of emerging proposals for the ethical transplantation of vital organs.
The person who asks, ‘Is there a right to life or a right to die?’ may be looking for a legal answer or a moral one. The inquirer looking for a legal answer may be wanting to know what are their present legal entitlements or obligations: ‘What must I do to avoid trouble with the law?’ or ‘What can I avoid doing without running into trouble with the law?’ For example, the nurse may want to know whether she has a duty to assist with an abortion or the duty to assist a patient to commit suicide. The patient may want to know whether they can terminate a pregnancy without fear of criminal sanction or involve their spouse in assisting with their death, confident that their partner will not face prosecution after the peaceful death which would come more quickly than if the patient simply accepted good palliative care. The questioner looking for a moral answer is not so much interested in the present way of dealing with life at either end of the life-cycle, but rather with pondering how best we and our society might in future deal with people in such situations. The moral questioner is concerned with asking, ‘What ought we do? In a more ideal world, what ought we do? Even in a messy and broken world, what ought we do? How could laws and policies best be formulated to regulate, guide and determine how people respond and act when confronting life at either end of the life-cycle?’ When speaking of the right to die, we are usually wrestling with the moral dilemma of how best to order the doctor–patient relationship, how best to provide legal underpinning for the decisions made by patients and their next of kin, and how best to allow a patient to decide their options for life or death. If there is a right to die, it is a right to die at the time and in the manner of one’s choosing?
The concept of natural law has a venerable past in the Western world, having its beginnings in ancient Greece. For example, in the Theban plays, Sophocles illustrates how human actions have to conform to the laws governing human beings that have been ordained by the gods. Natural law theory holds that an understanding of human nature reveals that there are basic human goods, which all human beings need in order to flourish and be fulfilled. Although there are differing views about what is to be included in the list of basic human goods, the broadest list includes life, work and play, beauty, truth, friendship, self-integration, peace of conscience, marriage and religion. Natural law holds that these goods are incommensurable, and one cannot be preferred over another – although some goods may be dominant in particular lives. Crucially, whether some goods dominate or not, we need to share in all the goods to some extent. This leads to some potential problems in terms of ethical decision-making.
The idea of a law
The idea of the natural law is very broad, and not only encompasses views about natural science and the laws governing natural phenomena, but also extends across a number of disciplines, such as law, politics, theology and, of course, ethics. In some respects, all of these areas in the natural law tradition intersect with one another, and arguably the natural law that lies at the base of all of these disciplines is the same natural law. It is claimed that it is the natural law that justifies our intuitions about what is morally right. It is morally right to do our best to heal our patients, for example, because one of the basic human goods is life and health. It is one we all need to lead flourishing lives. We shall provide a brief account of what we might understand by a natural law or law of nature, and then outline how the idea can be applied to develop a normative ethical theory with universal application.
In the last decade, there has been a resurgence of utilising a Kantian theoretical approach in healthcare ethical reasoning. Kant (1909, 1991, 1997) argues that morality does not depend on how one feels about a particular action, but rather on whether one approaches the action with a good will. Kant believes that the moral life is based purely and simply on duty or obligation, and not on a utilitarian calculation of the best consequences or on a natural law respect for the basic human goods. So Kant holds a deontological view of ethics – an ethics of duty or obligation. Kant says that the most important thing is to will to do what is rational to do, and what reason commands. He says that the principle according to which we should act is to do what we would want to be a universal law – that is, we would want everyone to act in the same way. In healthcare ethics, this means that duties and rights are taken into account in our ethical decision-making.
Kant’s deontological approach to ethics
Kant’s main discussion of ethics can be found in Groundwork for the Metaphysics of Morals (1997), The Critique of Practical Reason (1909) and The Metaphysics of Morals ((1991). The first of these is generally taken to encapsulate Kant’s novel contribution to the discussion of ethics. Throughout his work on ethics, Kant takes a contrary view to those who claim that we can determine what is morally good by an appeal to the good, which he claims we cannot know, as well as those – such as virtue ethicists – who claim that the end of ethical behaviour is happiness. The latter, he thinks, cannot adequately be established. Kant provides us with a view of ethics that he believes is based on reason, the distinguishing mark of a human being. He distrusts emotion, holding that doing what is good is an imperative of reason: the recognition of doing what is right and the will to do this, irrespective of how one feels about what one has to do.
Ethical principlism is a popular ethical theory in healthcare ethics. It is based around four principles: beneficence, non-maleficence, autonomy and justice. Some codes of ethics, which try to provide guidance in healthcare, make use of these principles. This chapter will first explore what each of these principles involves, consider some examples of the principles in action and look at some of the difficulties and limitations of principlism. Principlism is at its best when the four principles work together to provide a framework for moral action, and at its worst when principles come into conflict. For example, showing respect for patient autonomy may not always lead to treatment that would be in a patient’s best interests, and so could conflict with the principle of beneficence.
It is no surprise that when we discuss standards of moral conduct or seek guidance in moral decision-making that we appeal to moral principles that help us make decisions about how we should act. Different normative moral theories have different starting points, so we can arrive at different views about what is good and what is morally right. Different theories, starting from different principles, result in different moral rules. This suggests that where there are challenging moral issues in the healthcare area, there will be considerable difficulty in finding agreement about what course of action is morally appropriate. Ethical principlism is a possible way forward: it proposes that, despite differences among ethical theories, there is a common core morality, and invites us to consider our moral decision-making within a framework of four moral principles. That is, it is claimed that whatever our starting point in moral theory might be – whether it is utilitarianism, virtue ethics, deontology or natural law – if we begin from the framework of ethical principlism, then the more likely we are to reach an agreed decision on a moral question. The appeal of ethical principlism is that it will help us to make justifiable moral decisions rather than establish what is objectively morally right. Principlism assumes that because there will be an overlap among the various moral rules enunciated by different normative theories which yield a common core morality, there will be acceptance of the four principles that form the framework within which moral questions are considered.
‘In this year Ipswich was ravaged and quickly after that Ealdorman Byrhtnoth was slain at Maldon. And in this year tribute was first paid to the Danes because of the great terror they caused along the coast.’ Thus reports one version of the Anglo-Saxon Chronicle's annal for 991 (see 8/20–3 for the OE text). This incident at Maldon, in Essex on the east coast of England, might have gone unnoticed in the larger picture of defeat and capitulation which characterised England in the 990s; the Danes were stepping up their attacks, which would continue with little opposition from King Æthelred and his nobles until the Danish Cnut took the throne in 1016. But an anonymous poet ensured that posterity would know a little more about this particular defeat. Indeed, by invoking the old heroic ideals of his countrymen's Germanic past, and using the poetic style associated with the celebration of those ideals, he turned the dire events at Maldon into a sort of moral victory: English heroes died, but they died well.
How soon after August 991 the poem was written is not known, but nothing in its language or style precludes a more or less contemporary date. Yet its purpose in relation to current events is not clear. Stirring as the defiant speeches of loyal but doomed heroes may be, in practical terms they scarcely constitute an effective national rallying cry, and it may be that the poem had a more parochial aim, to commemorate the English leader Byrhtnoth. By all accounts the elderly ealdorman of Essex was an esteemed figure, and he seems to have been unusual in his willingness to stand up against the enemy. There is a strong possibility that the poem was written in one of the monasteries in eastern England which Byrhtnoth generously supported and where his memory would have been revered. In a Latin ‘Life’ of St Oswald, written a few years after 991 at Ramsey, also in East Anglia, Byrhtnoth figures prominently as a Christian martyr. In the Liber Eliensis (‘the Book of Ely’), moreover, written about 1170 but based on earlier and in some cases oral sources, two battles against the Danes at Maldon are recorded; the first is a triumphant victory for Byrhtnoth and his forces, the second a long and fruitless struggle against overwhelming odds.
‘He who knows many songs sorrows the less’, claims the poet of the OE Maxims I – and Deor seems to confirm this sentiment. It is a poem of consolation which draws on stock characters of Germanic legend to sketch a series of episodes of misfortune. Each episode is followed by a refrain which may be translated loosely as ‘That passed away, so can this’, and thus the philosophical detachment from the original misfortune allowed by the passage of time is transferred to a present calamity – ‘this’. We do not learn what ‘this’ is until the last section of the poem, where the speaker identifies himself as a scop (professional poet) called Deor, who has been expelled from his position with a great lord in favour of a rival called Heorrenda. The diction of Deor (with nouns such as earfoþ, sorg and wræc, compound adjectives such as winterceald and sorgcearig, and verbs such as drēosan and bidǣlan) links it very obviously with the other lyrical or elegiac OE poems given in this section – The Wanderer, The Wife's Lament and Wulf and Eadwacer. Like the poet of The Wanderer (in line 30), the Deor-poet uses the image of sorrow as a companion (line 3).
As a poem in strophic form, with a refrain, Deor is a rarity in OE literature, and the scribe of the Exeter Book has taken note of this, providing a large capital at the start of each section following the refrain. The form is not regular, however. The first five ‘stanzas’ have, respectively, seven, six, four, three and seven lines, including in each case the one-line refrain. Then follow fifteen lines which, though often printed as a complete sixth stanza, are set out below as two stanzas, of seven and eight lines. These two parts seem to be self-contained, though complementary: the first, a philosophical summing up of what has gone before, prepares us for the revelation of the second, namely the misfortune of Deor himself in the loss of his patron. Only the second, therefore, has the refrain.
Between about 990 and 995, at Cerne Abbas (see p. 40), Ælfric wrote two series of Sermones catholicae (usually called his Catholic Homilies today) which, to judge from the many surviving copies, were immensely popular not only during his lifetime but well into the thirteenth century. Each volume contains forty items, including both homilies and sermons (see section headnote), and also a few saints’ lives. Within each volume the various items are arranged chronologically, according to the use assigned to them at specific times during the church year, though there are a few sermons labelled to be read at any time.
In the preface to the first volume, Ælfric explains that he has put the homilies into plain speech, both for reading and for hearing, in order to edify ordinary people and thus, he hopes, to effect the salvation of their souls. He claims that he has seen much error in English books, a reference probably to compilations like the anonymous ‘Blickling Homilies’ and ‘Vercelli Homilies’, many of whose texts contain unorthodox material. For his own homilies, Ælfric drew on the work of the established fathers of the church, above all Jerome, Augustine, Gregory the Great and Bede, along with Smaragdus of Saint-Mihiel and Haymo of Auxerre. The two volumes were designed to form the basis of a comprehensive programme of orthodox teaching for Christians. Although the prefatory comments noted above suggest that Ælfric's primary audience was the laity, in which case the sermons and homilies would have been preached in parish churches, they nevertheless contain many passages which appear to be directed specifically at monks or at the secular clergy (see line 69 in the text below). There is evidence also that Ælfric expected private readers for his homilies, as well as auditors in monastic or church settings.
The fifteenth item in the first series of homilies, headed Dominica Pascae (Easter Sunday), has the typical homiletic structure of gospel extract, specific to the day in question, followed by an interpretation. In a church setting, we may imagine that the gospel reading for Easter Day has already been read from the Latin Vulgate, relating the visit of ‘the three Marys’ to Christ's tomb following his crucifixion and the angel's report of his resurrection (Mk 16.1–7).
The story told in Exodus, the second poem of the Junius manuscript (see p. 166), is at the heart of Jewish history, for it tells of the very survival of the race. The biblical version of the events covered in the poem is given very concisely in Ex 13.20–14.31. After a long captivity in Egypt, the Israelites have finally been allowed by Pharaoh to leave and are led away by Moses. But Pharaoh changes his mind and gives chase until he corners the fugitives at the Red Sea, whereupon Moses, at God's command, causes the waters to part so that the Israelites can pass safely across. When Pharaoh and his troops try to follow, the water returns and they are all drowned.
The extract given here comes from the dramatic climax of the poem. The terrified Egyptians have tried to follow the Israelites, only to find the sea overwhelming them. With impressive verbal virtuosity, the poet presents their destruction in a repetitive pattern of visual images of almost cinematographic intensity – using fourfold variation, for instance, to tell how the walls of water have come crashing down on the doomed army. There is an apocalyptic tone to all this, a clear allusion to the terrors of Judgement Day for the unrighteous. God's adversary, the poet declares, has found that God is greater than he is; the pride of the Egyptians has been smashed and such is the completeness of their annihilation that there is not even a messenger left to take the news of defeat back home.
After the action, Moses spells out to the Israelites the nature of God's covenant with them (lines 108–18), but first there is a homiletic digression apparently by the poet himself, who is clearly well versed in biblical exegesis (lines 77–102). He exhorts his audience to be open to the lessons of scripture, to recognise the ephemeral nature of life on earth, and to prepare for Judgement Day. Deliverance from this exile on earth will be the reward of the righteous.
Syntactically, Exodus presents the modern reader with special challenges. It is not always clear, for instance, whether certain half-lines complement the previous half-line (or even the one before that) or anticipate the next, and the interpretations and punctuation given below are necessarily subjective.
The Latin alphabet was introduced for the writing of OE by Christian monks soon after AD 600. It had twenty-three letters, lacking v (whose function was shared with u), j (which was not distinguished from i), and w. Of the twenty-three, q was used rarely; z occurred in biblical names and occasionally elsewhere for ‘ts’; x could be used to represent ‘ks’; and k was little used until towards the end of the Anglo-Saxon period (c being written instead).
The letters of Latin were augmented by four further characters – either invented, or borrowed from the runic alphabet, which had long been in use among the Germanic peoples, mainly for inscriptions. They are (with ‘capital’ forms in brackets):
þ (Þ) for ‘th’, a runic character with the name þorn (‘thorn’);
ð (Đ) also for ‘th’, formed by adding a cross-stroke to a d written in the Irish way, with a round back, and known by the Anglo-Saxons as ðæt, but today as ‘eth’. Thorn and eth were used without distinction, though individual scribes had their own preferences: a word such as siþþan might also be written siððan or even siþðan or siðþan.
æ (Æ) for a ‘fronted’ a-sound (see below); known by the Anglo-Saxons as æsc (‘ash’).
ƿ (Ƿ) for ‘w’, a runic character with the name wynn (‘joy’). In most modern printing of OE, as in this book, wynn is replaced by w.
These new characters were not in full use among the Anglo-Saxons until the end of the seventh century. Until then, th or d may be found instead of ð or þ (the latter taking longer to become established than ð), ae or e for æ, and uu or u for w. For examples, see Text 20a. In manuscripts written at the close of the Anglo-Saxon period, under Norman French influence, the digraph th is increasingly found again.
The letter-shapes in the manuscripts are mostly those that we recognise today, though the handwriting used by Anglo-Saxons was continuously evolving over the centuries. This often enables palaeographers to date manuscripts with a fair degree of precision.
Even as state persecution has shifted its focus to who people are, rather than what they believe, the modern world can still look a little medieval. In 2013, centuries after the Jewish community in Amsterdam in 1656 imposed its most severe ban upon the philosopher Baruch Spinoza (1632–77) for heresy, the community considered revoking it. The final decision was to let the ban remain in force. As Chief Rabbi of Amsterdam Pinchas Toledano asked, “Does freedom of speech mean that we in our synagogue should spread the denial of God's existence to the extent that it destroys our heritage and the pillars on which Judaism rests? ” Ibn Taymiyah may have died under a cloud of heresy in 1328, but modern Islamists have discovered in him an inspirational defender of Islam's purity, opposed to coexistence with, and the influence of, non-Muslims. Modern Christian denominations, both Catholic and Protestant, still occasionally conduct heresy trials over matters of theology, social teaching, and ecclesiastical discipline.
“The pillars on which Judaism [and Christianity, and Islam] rest” – whether sacred text, tradition, reason, direct revelation, collective consensus – are still, often frustratingly for believers, both fragile and contested, and indispensable. The individual can still be set against the community, and toleration can discover its limits in the essential, yet oddly changeable, foundations of faith. Our medieval events left legacies for modern Judaism, Christianity, and Islam, even as believers grapple with some of the same questions about right and wrong belief that their predecessors did. To understand better religious heresy in both the medieval and modern worlds, we should step back and take stock. What are the conclusions from our history of medieval heresies?
We should note first some differences and similarities among these histories in all three religions. The most obvious, and important, difference is a stateless Judaism, with Jews living in minority communities under Christian and Muslim rule.
In this chapter we review crucial aspects of functionalism, a theory of translation that enjoys a great deal of popularity in professional contexts because of its intuitive and practical appeal. Functionalism argues that the translation process is guided by extra-linguistic factors, more specifically by the function of the translation. Many translators often refer to functionalist notions without knowing that they are doing so. This chapter reviews some basic notions of functionalism, and it explains how to apply them in translation practice and discussion. It addresses such topics as: situational features, and how they affect both monolingual and translated texts; changes in situational features, and how they influence and guide translation decisions; translation norms, and how a translator uses them to make decisions on the situational features of the target text. Chapter 3 will also discuss language functions and translation functions by looking at language use (i.e., pragmatics) and its relevance to translation in more detail.
As mentioned above, functionalism is a theory of translation that argues that the translation process is guided by extra-linguistic factors, more specifically by the function of the translation, and that translators make translation decisions on the basis of the extra-linguistic factors surrounding the target text. In order to understand what this means, we start by considering the relationship between extra-linguistic factors and texts, progressing to translated texts and translation tasks.
Extra-linguistic factors and monolingual texts
Texts are embedded in situations or contexts that consist of non-linguistic elements, which determine linguistic form and are reflected in the text. These non-linguistic elements are often referred to as situational features, features of situation or extra-linguistic features (also factors). Among them are: the function, audience, medium, motive, time and place. Function is the purpose the text is trying to achieve. Some examples of textual functions are: to convince someone to buy a product; to inform audiences about the time and venue for an event; to teach the public how to develop healthy eating habits; to give instruction in the use of a computer program; to teach someone how to administer medication; to show how to assemble a piece of furniture; to express an opinion regarding a controversial political topic; to express feelings of sadness and dejection at the loss of a loved one, etc.
Centuries before their continental neighbours, for whom Latin long remained the major language of writing, the Anglo-Saxons had an extensive literature in their own vernacular – Old English. The opportunity for widespread literacy had come to them with their conversion to Christianity, which began with St Augustine's mission to Canterbury in 597. Within only a few years, the lawcode of the kingdom of Kent had been put into English, the first vernacular document that we know of (see Section II), and by the time of the Norman Conquest in 1066 there was no area of written discourse not represented by works in OE, whether as translations or original compositions.
Nevertheless, it was Latin which remained the official language of the church throughout the Anglo-Saxon period, and far beyond it. Key theological texts and the Bible were all in Latin, and so were divine services, and therefore would-be monks and priests among the native population (whose mother tongue was OE in its various dialectal varieties) had to learn it. A priority for the missionaries at Canterbury, and their successors throughout the group of Anglo-Saxon kingdoms which would eventually become England, was thus the setting up of schools. All monasteries and cathedrals of any size needed one, and naturally the medium of instruction, to begin with at least, would have to be the vernacular. OE ‘glosses’ to Latin school-texts from Canterbury have been preserved, and Bede tells us (in his Historia ecclesiastica gentis Anglorum: see p. 105) how he used English in order to teach novice monks the Creed and other essential elements of the Christian faith.
This bilingual process of teaching and learning persisted throughout the Anglo-Saxon period, as surviving teaching materials show. Some of these are the work of the monk and scholar Ælfric, who was in charge of the monastic school at Cerne Abbas in Dorset during the closing years of the tenth century. He was the product of a great revival in learning that had taken place in the wake of the important mid-century reform and expansion of the Benedictine monastic system in England. He devised his own teaching materials for the novice monks, including very young boys, in his charge.