PREFACE Tom Garrett's passing on New Year's Eve 1997 has dramatically altered our expectations and experience in writing this new edition. This book was initially Tom's idea and while his illness progressively removed him from the labor of writing subsequent editions, his intelligence and spirit nevertheless continued to animate our work. This edition has been accomplished without his presence and guidance, and for the two of us there is an incompleteness to this text that no amount of our time or effort could satisfy. We dedicate this text to his memory in the happy acknowledgment of his continuing influence. The fourth edition embodies several improvements over the third, but contains no dramatic structural alterations. Work has been done to clarify and improve the philosophical reflections that provide the context for the discussion of both principles and problems in the field. Further, we have attempted to provide a natural and unified discussion of the problems associated with the still contentious issues surrounding the end of life. To give added perspective we have provided occasional interludes on insights offered from cultural traditions that are not usually understood to be part of the mainstream discussion of American medical ethics. We have also enlarged the discussion of genetics research and, of course, updated information on many issues. As always, there are many people to thank for their contribution to this text. Several colleagues in the field offered their advice and suggestions regarding the revisions in a symposium organized by the University of Scranton. We thank them and the University for this opportunity. Dr. Baillie would also like to thank the University of Scranton for a sabbatical, during which work was completed for this edition. Our work on genetics research has been aided by the support of the Northeast Regional Cancer Institute, which received funding from the Department of Energy's Human Genome Project. We appreciate that support. Our students have provided a continuing opportunity to test the clarity of our thinking and have challenged our presentation with questions and problems that have enlightened and invigorated us. The medical and health care management communities in Scranton and in the Republic of Slovakia have been both teachers and students for us, providing us with anchors in the school of hard knocks. Thank you to Tom Hickey of the University of Michigan, Ann Arbor for his careful review. We would also like to thank Jennifer Ackerman, Emsal Hasan, and Edie Riker at Prentice Hall for their continued confidence in the book and their untiring efforts to bring this edition to completion. Several scholarly presses have provided us with permission to quote from their material, and we appreciate their continued generosity. Finally, and for the fourth time, we would like to thank Eleanore Cooper for her secretarial support so crucial to producing a manuscript, and for her persistent good humor throughout the trials of the last two years. Harold W. Baillie, Ph.D. Rosellen M. Garrett, R.N., Ph.D.Garrett, Thomas M. is the author of 'Health Care Ethics Principles and Problems', published 2000 under ISBN 9780130194480 and ISBN 0130194484.