2002年Text 4��

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 hospitals, 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."

57. Which of the following statements its true according to the text?��
[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.

[答案] C

[解題思路]

本題可以采用排除法。文章第五段的最后一句指出"If you're a physician, you can risk your patient's suicide as long as you don't intend their suicide"（假如你是一名醫生，只要你并沒有想讓病人自殺，你就可以去冒險給比病人治病），A選項的意思正好與原文相反。第六段中提到"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"（許多醫療界人士承認，致使醫助自殺這場爭論升溫的部分原因是由于病人們的絕望情緒而引起的，對這些病人來說，現代醫學延長了臨終前肉體上的痛苦），B選項的表述也與原文相反。同時，第五段第一句中指出"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"（只要醫生是出于合理的醫療目的開藥，那么即使服用此藥會加速病人的死亡，醫生的行為也沒有違法），因此醫生開藥是可以根據合理動機的，D選項錯誤。那么C選項就是正確答案，它雖然在文中沒有直接的表述，但是文章第二段通過"Although it ruled that there is no constitutional right to physician-assisted suicide, the Court in effect supported the medical principle of "double effect,""（盡管裁決認為，憲法沒有賦予醫生幫助病人自殺的權利，然而最高法庭實際上卻認可了醫療界的"雙重效應"原則）暗示了這一點，緊接著第三段中"Doctors have used that principle in recent years to justify using high doses of morphine to control terminally ill patients' pain"（醫生們一直在用這項原則，為自己替病�；颊咦⑸浯髣┝康膯岱孺偼吹淖龇ㄌ峁┱�當的理由）進而證明了這一點。

[題目譯文]

下面的哪一項符合文意？
[A] 醫生如果那病人的生命來冒險將被認為有罪。
[B] 現代醫學幫助晚期病人得到無痛康復。
[C] 最高法院裁定開大劑量能夠減輕痛苦的藥。
[D] 醫生開的藥不再由其動機決定。

58. 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.

[答案] B

[解題思路]

NAS的報告出現在文章的第七段，該段最后一句話說"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"（報告指出了醫院臨終關懷護理中存在的兩個問題：對減輕病痛處理不力和大膽使用"無效而強制性的醫療程序，這些程序可能會延長死亡期，甚至會讓死亡期難堪"），因此其中一個問題是對病痛的處理不力，答案顯然為B。其他三項內容都與該報告無關。

[題目譯文]

根據國家科學院的報告，臨終關懷的問題之一在于            。
[A] 延長了治療程序
[B] 對痛苦的處理不充分
[C] 系統性的藥物濫用
[D] 醫院的照料不夠

60. 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.

[答案] D

[解題思路]

安納斯關于文章最后一段的討論出現在文章最后一段，""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.""（"不少醫生對病人所遭受的毫無必要且可預見的痛苦無動于衷"，乃至于已構成"蓄意虐待病人"。他說，行醫資格理事會"必須明確......令人痛苦的死亡可以認定是治療不當造成的后果，應該吊銷行醫執照"），B、C選項顯然與原文內容不符，因此可以排除。A選項具有一定的迷惑性，但是manage patients incompletely是painful deaths的原因，而painful deaths才是license suspension的原因，因此D才是正確選項。

[題目譯文]

喬治·安納斯可能認為醫生應該受到處罰，如果他們              。
[A] 照顧病人并不盡力
[B] 為病人提供不必要的藥物
[C] 為病人較少用藥量
[D] 延長病人不必要的痛苦

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