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The Supreme Court’s decisions on physician-assisted suicide carry important implications for how medicine seeks to relieve dying

admin2010-05-05  40
问题     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 doctor 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 has-ten death. "George Annas, chief of the health law department at Boston University, maintains that, as long as a doctor pre-scribes 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."
选项 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
答案B
解析 文章细节事实题。题干要求从文章前三段中判断四个选项中哪一个是正确的表述。四个选项如下："医生曾经用增加药物剂量的方法来控制病人的疼痛"的时间与原文不符。"used to do"意为"过去常常做…事情(但现在不做了)"。文章第三段提到，近年来，医生一直使用这个原则为他们使用大剂量的吗啡来控制临死病人(terminally ill patients)的疼痛进行辩护。可见，最近医生也这么做。"医生帮助病人结束生命仍然是不合法的"就是文章第二段首句的改写。该句提到，法院在判决中承认医生协助病人自杀不是宪法赋予的权利。选项中的"illegal"对应文中"no constitutional right"，"doctors to help the dying end their lives"对应"physician—assisted suicide"。因此是正确答案。"最高法院强烈反对医生协助病人自杀"与原文意思相反。第二段明确提出，法院实际上对"双重效果"的医疗原则表示了支持，这里的"双重效果"就是指"医生协助病人自杀"。"病人没有宪法赋予的权利去自杀"在原文中未提及，文中只谈到医生没有宪法赋予的权利来协助病人自杀。
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