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
长难例句分析
［长难例句］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.
［结构分析］本句中，主句主干是the Court supported the medical principle of "double effect"。in effect作状语，a centuries-old moral principle作the medical principle的同位语。holding加上后面that引导的宾语从句作a centuries-old moral principle的定语，在这个定语从句中，主干是an action is permissible，现在分词结构having two effects — a good one that is intended and a harmful one that is foreseen作定语修饰an action，其中两个that引导的均是定语从句，if the actor intends only the good effect为条件状语从句。前面的Although it ruled that there is no constitutional right to physician-assisted suicide为状语从句，从句中that引导的是宾语从句。
［参考译文］尽管最高法院裁定宪法没有赋予医生协助病人自杀的权利，但最高法院事实上支持“双重效应”这一医疗准则。这个履行了数百年的医疗道德准则认为：假如一种行为具有两种效应——有以治病为目的的良好效应又有可预测的不利效应——但为了实现这一良好效应，医生被允许实施治疗而不用考虑其不利效应。
全文参考译文
最高法院对安乐死所做的裁定给正在探求减轻病危病人痛苦的医学界以重大支持。
尽管最高法院认为当前宪法还未承认使用安乐死这一权利。但最高法院事实上支持“双重效应”这一医疗准则。这个履行了数百年的医疗道德准则认为，假如一种行为具有两种效应——有以治病为目的的良好效应又有可预测的不利效应——但为了实现这一良好效应，医生被允许实施治疗而不用考虑其不利效应。
最近几年来，医生们一直在执行这一准则，大量使用吗啡来减轻濒危病人的病痛，尽管加大使用量会导致病人死亡。
蒙蒂菲利奥医疗中心主任Nancy Dubler认为，这一准则会为一些医生辩护。这些医生直到现在还在坚决主张假如增加使用量可能使病人死亡加速。因而他们不能为了减小病人疼痛而大量用药。
但波士顿大学健康法学系主任George Annas认为，医生开药只要是为了减少病人治病的，即使加速病人死亡，医生所做之事也不违法。他说道：这就像外科手术，尽管医生可能导致病人死亡，但医生的目的并不想把病人治死，因而我们不可以称这种死亡为谋杀。假如你是位内科医生，假如你的出发点不是让别人自杀，你就可以冒险给病人看病。
另外，医疗界很多人都承认安乐死的争论大部分是因为病人对治疗的绝望引发的。原因是现代医学使病人的疼痛延长。
在最主要法院对安乐死作出判定的前三个礼拜，国家科学院发表了一部两册本的报告《临近死亡：改善临终看护》，该报告把对减缓病人疼痛做得不够和坚持实施无用和强制性医疗方式从而导致病人垂死时间延长，导致病人临死时深受煎熬，确定为临终看护上存在的两大问题。
现医学专业界正采取措施要求年轻医生在晚期病人收容院接受培训，以便检查他们对剧痛治疗知识的认识，制定新标准评定和料理病人的临终苦痛。
Annas说，在坚决要求这些善意的医疗动机应转化为更好的看护行动这方面，律师们可能起着关键作用。他说：“很多医生好像对可预测到的，病人不用遭遇的痛苦视而不见，导致病痛给病人造成了连续的伤害。”他还说行医许可证颁发机构“必须明白……让人痛苦的死亡可以测定是治疗不当导致的结果，应当取消其行医资格”。
题目答案与解析
1.我们从前三段了解到，________。
A.医生过去常常增加药量来控制病人的痛苦
B.医生帮助垂死病人结束生命仍然是违法的
C.最高法院强烈反对医生协助的自杀
D.宪法没有赋予病人自杀的权利
【答案】B
【解析】从文章前三段的内容可知，最高法院就医生协助的自杀所做的裁决，对医学界如何寻求解除垂死病人的痛苦与折磨具有重要意义；尽管最高法院裁定宪法没有赋予医生协助病人自杀的权利，但是，最高法院实际上支持“双重效应”的医疗准则——如果行为人只想要良好的效果，那么一种具有双重效果的行为就是可以容许的；近几年来，医生已经利用这一原则来为自己使用大剂量的吗啡控制晚期病人的痛苦而辩护，尽管加大剂量最终会导致病人死亡。据此可知，最高法院认为医生没有协助病人自杀的权利。B项与文章的意思相符，因此为正确答案。
2.依照本篇文章的观点，以下哪项是说法正确的？
A.如果医生冒着导致病人死亡的危险，他们将被认为有罪。
B.现代医学已经帮助那些晚期病人在无痛苦中康复。
C.法院裁定，医生可以开大剂量减轻病痛的药物。
D.医生的用药是否恰当不再取决于他的目的。
【答案】C
【解析】本题可参照文章的第二、第三段。从中可知，尽管最高法院裁定宪法没有赋予医生有协助病人自杀的权利，但是，最高法院实际上支持“双重效应”的医疗准则——如果行为人只想要良好的效果，那么一种具有双重效果的行为就是可以容许的；近几年来，医生已经利用这一原则来为自己使用大剂量的吗啡控制晚期病人的痛苦而辩护，尽管加大剂量最终会导致病人死亡。由此可知：最高法院认为，医生可以使用大剂量药物来减轻晚期病人的痛苦。C项与文章的意思相符，因此为正确答案。
3.依照国家科学院的报告，在临终护理中存在的问题之一是________。
A.延长的治疗过程 B.缺乏对痛苦的医治
C.有计划地滥用药物 D.医院的护理不适当
【答案】B
【解析】本题可参照文章的第七段。从中可知，就在最高法院对医生协助病人自杀作出裁决的三个星期之前，国家科学院发表了一份两册的报告；该报告认为，对病人的痛苦处理不足以及大胆使用“可能延长甚至不尊重死亡时期的无效、强制性医疗手段”是临终护理中并存的两个问题。据此可知，报告认为，对病人的痛苦处理不足是临终护理存在的问题之一。B项与文章的意思相符，因此为正确答案。
4.以下单词中，哪个最好地解释了单词“aggressive”（第七段第三行）的意思？
A.大胆的。 B.有害的。 C.粗心的。 D.不顾一切的。
【答案】A
【解析】从文章第七段的内容可知，就在最高法院对医生协助病人自杀作出裁决的三个星期之前，国家科学院发表了一份报告；该报告认为，对病人的痛苦处理不足以及大胆使用“可能延长甚至不尊重死亡时期的无效、强制性医疗手段”是临终护理中并存的两个问题；从第八段的内容可知，医学界正在采取措施，要求年轻医生到临终关怀所实习，要求他们测试有关大胆的疼痛处理疗法方面的知识。据此可知，aggressive一词应意为“有闯劲的、大胆的”。A项与文章的意思相符，因此为正确答案。
5.George Aanas可能赞成，医生应该受到惩罚，如果他们________。
A.治疗病人不得力 B.给病人的药超过所需的量
C.减少病人的用药量 D.延长病人不必要的痛苦
【答案】D
【解析】本题可参照文章的最后一段。从中可知，Annas认为，在坚决要求这些善意的医疗动机应该转化成更好的护理行动这个方面，律师能够起关键作用；他说，许多医生似乎对病人遭受的不必要的、可以预见的痛苦漠不关心，甚至到了有计划地虐待病人的程度；他还说，医师执照颁发委员会必须明确——痛苦的死亡如被推定为是由于治疗不得力而造成的，医生将被吊销执照。据此可知，他可能认为，如果医生造成病人痛苦的死亡，应当吊销他们的执照。D项与文章的意思相符，因此为正确答案。
