歷年考研英語(yǔ)閱讀理解2002年04

[00:03.85]2002 Text4 [00:07.78]The Supreme Court's decisions on physician-assisted [00:10.92]suicide carry important implications [00:13.64]for how medicine seeks to relieve dying patients of [00:16.66]pain and suffering. [00:19.18]Although it ruled that there is no constitutional [00:21.70]right to physician-assisted suicide, [00:24.29]the Court in effect supported the medical principle [00:27.29]of "double effect," [00:28.99]a centuries-old moral principle holding [00:31.93]that an action having two effects [00:34.64]--a good one that is intended [00:36.18]and a harmful one that is foreseen [00:39.00]--is permissible if the actor intends [00:41.28]only the good effect. [00:43.80]Doctors have used that principle in recent years [00:46.91]to justify using high doses of morphine [00:50.14]to control terminally ill patients' pain, [00:53.06]even though increasing dosages [00:55.08]will eventually kill the patient. [00:58.21]Nancy Dubler, director of Montefiore Medical Center, [01:01.95]contends that the principle will shield doctors [01:04.86]who "until now have very,very strongly [01:08.08]insisted that they could not [01:09.78]give patients sufficient medication to control [01:12.10]their pain if that might hasten death." [01:16.43]George Annas, chair of the health law department [01:19.26]at Boston University, [01:21.18]maintains that, as long as a doctor [01:23.29]prescribes a drug for a legitimate medical purpose, [01:26.83]the doctor has done nothing illegal even if [01:29.85]the patient uses the drug to hasten death. [01:32.77]"It's like surgery," he says. [01:35.29]"We don't call those deaths homicides [01:37.41]because the doctors didn't intend to [01:39.18]kill their patients, [01:40.55]although they risked their death. [01:42.83]If you're a physician, [01:44.39]you can risk your patient's suicide as long as [01:47.42]you don't intend their suicide." [01:50.74]On another level, [01:52.16]many in the medical community acknowledge [01:54.48]that the assisted-suicide debate has been fueled [01:57.31]in part by the despair of patients [01:59.72]for whom modern medicine [02:01.23]has prolonged the physical agony of dying. [02:04.86]Just three weeks before the Court's ruling on [02:07.48]physician-assisted suicide, [02:09.60]the National Academy of Science (NAS) [02:12.82]released a two-volume report, [02:15.24]Approaching Death: Improving Care at the End of Life. [02:19.79]It identifies the undertreatment of pain [02:22.21]and the aggressive use of "ineffectual [02:24.83]and forced medical procedures [02:26.95]that may prolong and even dishonor [02:29.36]the period of dying" [02:30.63]as the twin problems of end-of-life care. [02:34.74]The profession is taking steps to require [02:37.27]young doctors to train in hospices, [02:40.70]to test knowledge of aggressive pain management therapies, [02:44.42]to develop a Medicare billing code for hospital-based care, [02:48.25]and to develop new standards for assessing [02:50.98]and treating pain at the end of life. [02:54.00]Annas says lawyers can play a key role in insisting [02:57.83]that these well-meaning medical initiatives [03:00.35]translate into better care. [03:02.97]"Large numbers of physicians seem unconcerned with [03:06.00]the pain their patients are needlessly and predictably suffering," [03:10.22]to the extent that it constitutes "systematic patient abuse." [03:14.66]He says medical licensing boards [03:17.01]"must make it clear... [03:18.29]that painful deaths are presumptively ones [03:21.01]that are incompetently managed [03:22.33]and should result in license suspension."

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