In 1971, Van Rensselaer Potter published Bioethics: Bridge to the Future and defined “bioethics” as an ethics based on biological survival. In his first book, he dealt with subjects such as stress, toxic hazards, ecology, biotechnology, and population growth. In his 1988 book, Global Bioethics, Potter added topics discussed by more mainstream bioethicists: disabled newborns, organ transplantation, euthanasia, and contraception. However, the later book maintained an interest in ecology, population change, and an emphasis on human survival. Potter’s vision of bioethics concerns healthcare and healthcare providers, but it also encompasses ethical duties of all members of society. The fact that he did not write specifically on the ethics in medical care facilities may explain why his work is little more than a footnote in most bioethics texts.
Potter poses two challenges to bioethics as generally practiced or presented. First, he presents bioethical duties as human duties rather than professional duties, although some duties or specific actions are of course related to one’s profession. Second, bioethical duties extend beyond health care to care for the living earth. He challenges doctors to look beyond the bedside, and enjoins lay people to accept responsibility for improving the chances for biological survival. Had his work been taken more seriously, bioethics may have reached beyond topics related to medical dilemmas and instead have comprised diverse subjects such as war, famine, genetically modified food, corporate responsibility, and individual responsibility. Such an approach may have better prepared us for substantial threats to global health in the twenty-first century.
Christian Frei’s 2001 film, War Photographer, is a documentary of the work of photographer James Nachtwey. The film depicts scenes of suffering resulting from poverty, famine and war: the sorts of issues Potter would define as bioethical concerns. In a sense, the film poses a sort of double aesthetic; it is beautifully filmed and exposes the viewer to the achingly attractive photography of James Nactwey. The aesthetic qualities of the film place the viewer in a bind, however, as the images are generally of horrific events of human cruelty and suffering. Nachtwey has made a career of filming the effects of famine, war, disease, and poverty. To his mind, this is a moral act, but his narration reveals ambivalence. He assures his interviewer that he only photographs with the complicity of his subjects, that he only shows his subjects in a respectful manner, and that his only motivation is to improve the plight of humans in this world as Potter exhorts us to do when he says, “I will try to adopt a lifestyle and to influence the lifestyle of others so as to promote the evolution of a better world for future generations of the human species.”
Nachtwey’s attempts to explain and justify his career only highlight the underlying issues. How can a person dying of cholera or starvation give consent to be photographed? Is it possible for a mother who has just learned of the death of her son or husband to make an informed decision about how images of her might be used in the media? Nachtwey wants his subjects to be joint contributors to his cause of publicizing events in the world and, with a bit of luck, bringing some relief. Indeed, he tells us he will only film victims of famine when relief workers are present. Nachtwey clearly would hate to make his fame and fortune exploiting the suffering of his fellow human beings. The film does not reveal Nachtwey’s net worth or his contributions to relief in the form of donations or volunteering, but he is presented as a dedicated individual with little concern for his personal comfort or safety.
The fact remains that Nachtwey has garnered fame and attention for his photographs, and he may well violate Kant’s injunction against using others as a means to one’s own ends. Without dealing with Kant explicitly, Nachtwey claims that his goal is merely to help his subjects meet their own ends. He assumes his subjects do not want to be victims of war, poverty, and famine, so he makes every effort to publicize their plight in hopes of securing relief. If we fault Nachtwey for his project, then we may also fault writers (bioethicists among them) who publicize tragic events in order to publish in journals and advance their careers. It may be that Nachtwey is merely a more effective bioethicist (at least in the sense intended by Potter) than those who publish in journals or even the popular press. Publishing in internationally distributed magazines such as Geo and Time Magazine, Nachtwey reaches millions of affluent individuals and confronts them with compelling images.
Nachtwey’s work could be compared to that of philosopher and ethicist Peter Unger. Author of Living High and Letting Die: Our Illusion of Innocence, Unger is a successful academic whose work has reached somewhat beyond the walls of the academy. Unger shares Nachtwey’s desire to motivate action to relieve the world’s suffering. Unger begins with an optimistic assumption that any rational reader would agree that it would be morally repugnant to stand by and let someone lose a limb when such a loss could be prevented by a relatively small sacrifice. For example, if I could prevent the loss of limb by giving someone a dollar, I would be morally wrong to keep my dollar. Unger realizes, however, that there is a point where we will no longer give up our dollars. Even if I agree that a child’s life is worth more than $200, I may not be willing to give up $200 each week even if I can afford it by abstaining from all luxury and recreational spending. We are left with a form of the sorites paradox. Anyone who would give up a dollar to save a child would probably give up two dollars. Finding the point where moral motivation encounters selfish (egoistic) resistance is the challenge of ethicists and relief agencies. Unger and others leave us with a challenge that we must make greater demands on ourselves than most of us are currently making.
Nachtwey appears to assume, also, that most of his viewers in affluent societies will feel it is inappropriate to witness preventable suffering and take no action to alleviate it. He enters no debate as to how much any one person should do; he merely attempts to make suffering visible and personal. He believes this is an action required of him by basic morality. In this sense, Nachtwey is both moral agent and ethicist. He is attempting to both act morally and to motivate others to adopt his moral position. The endeavor is somewhat risky. Some individuals involved in attempting to provide relief to the poorest people in the world warn against the use of “disaster porn.” One fear is that some viewers will feel that by watching the images they have somehow done something significant on the face of it without actually taking action to alleviate suffering. Affluent people may watch the images, comment on the beauty of the photography, praise the dignity of those suffering, cry a few tears, exhort others to view the images, and then go about their normal routine.
Another concern is that the photographer, film makers, and viewers are all using the individuals depicted to their own ends. From a consequentialist, or Utilitarian, perspective, the ends may seem to justify the means. If distribution of disturbing images brings relief to victims of war, famine, and poverty, then the use of the images seems not only justified but noble. Complications arise, however, if we cannot be sure the images are bringing relief. We may feel the effort is good, but it is only a good if it has a good result, and verification of such results is difficult at best. More troubling is the fact that we may be viewing (or making) the images for reasons that have nothing to do with relieving suffering. The images are beautiful and bring some pleasure to those viewing. As a result, the images sell movies, books, and magazines in addition to winning awards.
In War Photographer, Nachtwey reads letters he received from some of his viewers who were moved to help the individuals depicted in published photographs. Viewers of the film are reassured that the images are having a positive effect. We do not know, however, whether profits from Nachtwey’s images and Frei’s film are used to help the individuals depicted in the film and the photographs. One would guess not as the people in refuge camps, famine relief camps, and battles are most likely anonymous to Nachtwey and the filmmakers. Even if they are not anonymous, many are too ill or too busy fighting to give consent to be filmed, have their images displayed internationally, or to even support relief efforts. As mentioned above, Nachtwey says in the film’s narration that he could not do his work without the collaboration of his subjects. At times, it seems he is trying as hard to convince himself as he is to convince his viewers. One particularly disturbing scene is of a man in Indonesia who is being murdered for no real reason. While taking the photographs, Nachtwey pleas with the aggressors to stop their violence. He tells them there is no reason to kill the man, and he continues taking pictures. It is impossible to imagine that the victim of this senseless violence consented to have his murder filmed and sold. Nachtwey is not the only one who recorded the event, and other photographers probably did not consider their actions unethical. In fact, they were probably glad of their good fortune to be present for the event. Nachtwey, however, suffers some moral crises and invites his viewers to suffer these moral crises with him.
In the end, we must all decide the value of recording and viewing extreme suffering with or without the consent of those suffering. We may view victims of famine as objects of care more than as moral agents. They have lost the ability to make autonomous decisions regarding their images and have also lost the ability to be joint collaborators in the projects of Nachtwey and Frei. We may use surrogate judgment and claim that they would want to be given a voice to the outside world, and this conclusion seems reasonable. If affluent citizens will respond to the suffering, they will be motivated by their knowledge of the suffering, and the disturbing images are likely to provoke at least some people to take positive action. While watching the film or simply viewing Nachtwey’s photographs, we may feel guilty for not doing more to end suffering, for violating the privacy and dignity of those depicted, and for taking pleasure in the beauty of the photographs. Our guilt may motivate us to examine our moral impulses and actions, and we may become better as a result.
Bioethics is not simply medical ethics, and the obligations of bioethics apply to everyone. Potter, Unger, Nachtwey, and Frei have a single message in this regard: improving the conditions for human life requires a collective will, not just the concern of healthcare providers. At the same time, healthcare providers have the same obligation to look beyond the walls of the clinic or hospital to the suffering, preventable or not, that exists in the world. They are not obligated to do so out of professional duty; they are obligated to do so out of human duty. If bioethicists generally recognized this shared duty to recognize and respond to suffering, public and professional views on moral responses to public health, infectious diseases, pandemics, pollution, and poverty might be framed quite differently. If a global community of moral agents does not exist, it may be imperative to make an effort to form one.
 His wesite, www.jamesnachtwey.com, lists the following awards, “the Common Wealth Award, Martin Luther King Award, Dr. Jean Mayer Global Citizenship Award, Henry Luce Award, Robert Capa Gold Medal (five times), the World Press Photo Award (twice), Magazine Photographer of the Year (seven times), the International Center of Photography Infinity Award (three times), the Leica Award (twice), the Bayeaux Award for War Correspondents (twice), the Alfred Eisenstaedt Award, the Canon Photo essayist Award and the W. Eugene Smith Memorial Grant in Humanistic Photography. He is a fellow of the Royal Photographic Society and has an Honorary Doctorate of Fine Arts from the Massachusetts College of Arts.