[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
[02:09.60]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."内容来自 听力课堂网：http://www.tingclass.net/show-8686-251446-1.html