The Supreme Court's decisions on physician-assisted suicide carry important implications for how medicine seeks to relieve dying patients of pain and suffering.
Although it ruled that there is no constitutional right to physician-assisted suicide, the Court in effect supported the medical principle of "double effect", a centuries-old moral principle holding that an action having two effects — a good one that is intended and a harmful one that is foreseen — is permissible if the actor intends only the good effect.
Doctors have used that principle in recent years to justify using high doses of morphine to control terminally ill patients' pain, even though increasing dosages will eventually kill the patient.
Nancy Dubler, director of Montefiore Medical Center, contends that the principle will shield doctors who "until now have very, very strongly insisted that they could not give patients sufficient mediation to control their pain if that might hasten death."
George Annas, chair of the health law department at Boston University, maintains that, as long as a doctor prescribes a drug for a legitimate medical purpose, the doctor has done nothing illegal even if the patient uses the drug to hasten death. "It's like surgery," he says. "We don't call those deaths homicides because the doctors didn't intend to kill their patients, although they risked their death. If you're a physician, you can risk your patient's suicide as long as you don't intend their suicide."
On another level, many in the medical community acknowledge that the assisted-suicide debate has been fueled in part by the despair of patients for whom modern medicine has prolonged the physical agony of dying.
Just three weeks before the Court's ruling on physician-assisted suicide, the National Academy of Science (NAS) released a two-volume report, Approaching Death: Improving Care at the End of Life. It identifies the undertreatment of pain and the aggressive use of "ineffectual and forced medical procedures that may prolong and even dishonor the period of dying" as the twin problems of end-of-life care.
The profession is taking steps to require young doctors to train in hospices, to test knowledge of aggressive pain management therapies, to develop a Medicare billing code for hospital-based care, and to develop new standards for assessing and treating pain at the end of life.
Annas says lawyers can play a key role in insisting that these well-meaning medical initiatives translate into better care. "Large numbers of physicians seem unconcerned with the pain their patients are needlessly and predictably suffering," to the extent that it constitutes "systematic patient abuse." He says medical licensing boards "must make it clear...that painful deaths are presumptively ones that are incompetently managed and should result in license suspension."
1.From the first three paragraphs, we learn that_______.
A.doctors used to increase drug dosages to control their patients' pain
B.it is still illegal for doctors to help the dying end their lives
C.the Supreme Court strongly opposes physician-assisted suicide
D.patients have no constitutional right to commit suicide
2.Which of the following statements is true according to the passage?
A.Doctors will be held guilty if they risk their patients' death.
B.Modern medicine has assisted terminally ill patients in painless recovery.
C.The Court ruled that high-dosage pain-relieving medication can be prescribed.
D.A doctor's medication is no longer justified by his intentions.
3.According to the NAS's report, one of the problems in end-of-life care is_______.
A.prolonged medical procedures B.inadequate treatment of pain
C.systematic drug abuse D.insufficient hospital care
4.Which of the following best defines the word "aggressive" (Line 3, Para. 7)?
A.Bold. B.Harmful. C.Careless. D.Desperate.
5.George Annas would probably agree that doctors should be punished if they_______.
A.manage their patients incompetently B.give patients more medicine than needed
C.reduce drug dosages for their patients D.prolong the needless suffering of the patients
長難例句分析
［長難例句］Although it ruled that there is no constitutional right to physician-assisted suicide, the Court in effect supported the medical principle of "double effect", a centuries-old moral principle holding that an action having two effects — a good one that is intended and a harmful one that is fore seen — is permissible if the actor intends only the good effect.
［結(jié)構(gòu)分析］本句中，主句主干是the Court supported the medical principle of "double effect"。in effect作狀語，a centuries-old moral principle作the medical principle的同位語。holding加上后面that引導的賓語從句作a centuries-old moral principle的定語，在這個定語從句中，主干是an action is permissible，現(xiàn)在分詞結(jié)構(gòu)having two effects — a good one that is intended and a harmful one that is foreseen作定語修飾an action，其中兩個that引導的均是定語從句，if the actor intends only the good effect為條件狀語從句。前面的Although it ruled that there is no constitutional right to physician-assisted suicide為狀語從句，從句中that引導的是賓語從句。
［參考譯文］盡管最高法院裁定憲法沒有賦予醫(yī)生協(xié)助病人自殺的權(quán)利，但最高法院事實上支持“雙重效應”這一醫(yī)療準則。這個履行了數(shù)百年的醫(yī)療道德準則認為：假如一種行為具有兩種效應——有以治病為目的的良好效應又有可預測的不利效應——但為了實現(xiàn)這一良好效應，醫(yī)生被允許實施治療而不用考慮其不利效應。
全文參考譯文
最高法院對安樂死所做的裁定給正在探求減輕病危病人痛苦的醫(yī)學界以重大支持。
盡管最高法院認為當前憲法還未承認使用安樂死這一權(quán)利。但最高法院事實上支持“雙重效應”這一醫(yī)療準則。這個履行了數(shù)百年的醫(yī)療道德準則認為，假如一種行為具有兩種效應——有以治病為目的的良好效應又有可預測的不利效應——但為了實現(xiàn)這一良好效應，醫(yī)生被允許實施治療而不用考慮其不利效應。
最近幾年來，醫(yī)生們一直在執(zhí)行這一準則，大量使用嗎啡來減輕瀕危病人的病痛，盡管加大使用量會導致病人死亡。
蒙蒂菲利奧醫(yī)療中心主任Nancy Dubler認為，這一準則會為一些醫(yī)生辯護。這些醫(yī)生直到現(xiàn)在還在堅決主張假如增加使用量可能使病人死亡加速。因而他們不能為了減小病人疼痛而大量用藥。
但波士頓大學健康法學系主任George Annas認為，醫(yī)生開藥只要是為了減少病人治病的，即使加速病人死亡，醫(yī)生所做之事也不違法。他說道：這就像外科手術(shù)，盡管醫(yī)生可能導致病人死亡，但醫(yī)生的目的并不想把病人治死，因而我們不可以稱這種死亡為謀殺。假如你是位內(nèi)科醫(yī)生，假如你的出發(fā)點不是讓別人自殺，你就可以冒險給病人看病。
另外，醫(yī)療界很多人都承認安樂死的爭論大部分是因為病人對治療的絕望引發(fā)的。原因是現(xiàn)代醫(yī)學使病人的疼痛延長。
在最主要法院對安樂死作出判定的前三個禮拜，國家科學院發(fā)表了一部兩冊本的報告《臨近死亡：改善臨終看護》，該報告把對減緩病人疼痛做得不夠和堅持實施無用和強制性醫(yī)療方式從而導致病人垂死時間延長，導致病人臨死時深受煎熬，確定為臨終看護上存在的兩大問題。
現(xiàn)醫(yī)學專業(yè)界正采取措施要求年輕醫(yī)生在晚期病人收容院接受培訓，以便檢查他們對劇痛治療知識的認識，制定新標準評定和料理病人的臨終苦痛。
Annas說，在堅決要求這些善意的醫(yī)療動機應轉(zhuǎn)化為更好的看護行動這方面，律師們可能起著關(guān)鍵作用。他說：“很多醫(yī)生好像對可預測到的，病人不用遭遇的痛苦視而不見，導致病痛給病人造成了連續(xù)的傷害。”他還說行醫(yī)許可證頒發(fā)機構(gòu)“必須明白……讓人痛苦的死亡可以測定是治療不當導致的結(jié)果，應當取消其行醫(yī)資格”。
題目答案與解析
1.我們從前三段了解到，________。
A.醫(yī)生過去常常增加藥量來控制病人的痛苦
B.醫(yī)生幫助垂死病人結(jié)束生命仍然是違法的
C.最高法院強烈反對醫(yī)生協(xié)助的自殺
D.憲法沒有賦予病人自殺的權(quán)利
【答案】B
【解析】從文章前三段的內(nèi)容可知，最高法院就醫(yī)生協(xié)助的自殺所做的裁決，對醫(yī)學界如何尋求解除垂死病人的痛苦與折磨具有重要意義；盡管最高法院裁定憲法沒有賦予醫(yī)生協(xié)助病人自殺的權(quán)利，但是，最高法院實際上支持“雙重效應”的醫(yī)療準則——如果行為人只想要良好的效果，那么一種具有雙重效果的行為就是可以容許的；近幾年來，醫(yī)生已經(jīng)利用這一原則來為自己使用大劑量的嗎啡控制晚期病人的痛苦而辯護，盡管加大劑量最終會導致病人死亡。據(jù)此可知，最高法院認為醫(yī)生沒有協(xié)助病人自殺的權(quán)利。B項與文章的意思相符，因此為正確答案。
2.依照本篇文章的觀點，以下哪項是說法正確的？
A.如果醫(yī)生冒著導致病人死亡的危險，他們將被認為有罪。
B.現(xiàn)代醫(yī)學已經(jīng)幫助那些晚期病人在無痛苦中康復。
C.法院裁定，醫(yī)生可以開大劑量減輕病痛的藥物。
D.醫(yī)生的用藥是否恰當不再取決于他的目的。
【答案】C
【解析】本題可參照文章的第二、第三段。從中可知，盡管最高法院裁定憲法沒有賦予醫(yī)生有協(xié)助病人自殺的權(quán)利，但是，最高法院實際上支持“雙重效應”的醫(yī)療準則——如果行為人只想要良好的效果，那么一種具有雙重效果的行為就是可以容許的；近幾年來，醫(yī)生已經(jīng)利用這一原則來為自己使用大劑量的嗎啡控制晚期病人的痛苦而辯護，盡管加大劑量最終會導致病人死亡。由此可知：最高法院認為，醫(yī)生可以使用大劑量藥物來減輕晚期病人的痛苦。C項與文章的意思相符，因此為正確答案。
3.依照國家科學院的報告，在臨終護理中存在的問題之一是________。
A.延長的治療過程 B.缺乏對痛苦的醫(yī)治
C.有計劃地濫用藥物 D.醫(yī)院的護理不適當
【答案】B
【解析】本題可參照文章的第七段。從中可知，就在最高法院對醫(yī)生協(xié)助病人自殺作出裁決的三個星期之前，國家科學院發(fā)表了一份兩冊的報告；該報告認為，對病人的痛苦處理不足以及大膽使用“可能延長甚至不尊重死亡時期的無效、強制性醫(yī)療手段”是臨終護理中并存的兩個問題。據(jù)此可知，報告認為，對病人的痛苦處理不足是臨終護理存在的問題之一。B項與文章的意思相符，因此為正確答案。
4.以下單詞中，哪個最好地解釋了單詞“aggressive”（第七段第三行）的意思？
A.大膽的。 B.有害的?！.粗心的?！.不顧一切的。
【答案】A
【解析】從文章第七段的內(nèi)容可知，就在最高法院對醫(yī)生協(xié)助病人自殺作出裁決的三個星期之前，國家科學院發(fā)表了一份報告；該報告認為，對病人的痛苦處理不足以及大膽使用“可能延長甚至不尊重死亡時期的無效、強制性醫(yī)療手段”是臨終護理中并存的兩個問題；從第八段的內(nèi)容可知，醫(yī)學界正在采取措施，要求年輕醫(yī)生到臨終關(guān)懷所實習，要求他們測試有關(guān)大膽的疼痛處理療法方面的知識。據(jù)此可知，aggressive一詞應意為“有闖勁的、大膽的”。A項與文章的意思相符，因此為正確答案。
5.George Aanas可能贊成，醫(yī)生應該受到懲罰，如果他們________。
A.治療病人不得力 B.給病人的藥超過所需的量
C.減少病人的用藥量 D.延長病人不必要的痛苦
【答案】D
【解析】本題可參照文章的最后一段。從中可知，Annas認為，在堅決要求這些善意的醫(yī)療動機應該轉(zhuǎn)化成更好的護理行動這個方面，律師能夠起關(guān)鍵作用；他說，許多醫(yī)生似乎對病人遭受的不必要的、可以預見的痛苦漠不關(guān)心，甚至到了有計劃地虐待病人的程度；他還說，醫(yī)師執(zhí)照頒發(fā)委員會必須明確——痛苦的死亡如被推定為是由于治療不得力而造成的，醫(yī)生將被吊銷執(zhí)照。據(jù)此可知，他可能認為，如果醫(yī)生造成病人痛苦的死亡，應當?shù)蹁N他們的執(zhí)照。D項與文章的意思相符，因此為正確答案。
