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

admin2014-02-27  64
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 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 medication 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."  
According to the NAS’s report, one of the problems in end-of-life care is______.
选项 A、prolonged medical procedures
B、inadequate treatment of pain
C、systematic drug abuse
D、insufficient hospital care
答案B
解析 这是一道细节题。题干中的信号词为report，出自于文章第七段中。文章第七段指出：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和大胆使用“可能延长甚至不尊重死亡时期的无效的强制性医疗手段”是临终护理存在的两个问题。这说明，国家科学院的报告认为，对病人的痛苦处理不足是临终护理存在的问题之一。B说“缺乏对痛苦的医治”，这与文章的意思相符。文中提到prolonged时是说“大胆使用‘可能延长甚至不尊重死亡时期的无效的强制性医疗手段’是临终护理存在的问题之一”，这说明A不是临终护理存在的问题之一。文章最后一段指出：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；但这并不是临终护理存在的问题，所以C不对。文中是说“临终护理对病人的痛苦处理不足是存在的问题”，并没有说医院的护理不适当是存在的问题，所以D不对。
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