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Manhunt to Mortal Kombat: The Use and Future Use of Violence in Games (03 Sep 2004)
There are a number of factors that kept both Medal of Honor and Call of Duty in the Teen category," says Pat Vance, head of the ESRB. They are straight, historical simulations for one thing. They are non-gratuitous in terms of the types of injuries they depict. The amount of blood in these games is minimal. There's no friendly fire. "These are straight World War II simulations, and the developers made a concerted decision not to include the more gratuitous injuries and other things that you might find depicted in an M-rated game."

According to David Jaffe, director of Sony's Twisted Metal franchise and the upcoming God of War, stripping the gore out of games can diminish their impact. "I think you might be able to [separate the gore from the violence], but it's not as simple as shooting someone and simply not having any blood. The Medal of Honor games do this. I love those games, but without the blood, they just don't have visceral impact. They feel watered down.

"I think the idea of creating impactful violence without gore is very interesting. I have not really thought about it because up until now, my games have been arcade-like, fast-paced titles. I think it would be really hard to create violence without gore in that genre."

If there is a genre in which violence and gore have been successfully extricated, it's fighting games. The first one-on-one combat games, such as the Vectorbeam game Warrior, were bloodless because of the limitations of the hardware. Even when Street Fighter II suddenly made fighting games arcade headliners, fighters remained unblemished for the most part. Then came Mortal Kombat.
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