醫(yī)生殺人不犯法

　　1、The Supreme Court's decisions on physician-assisted suicide carry important implications for how medicine seeks to relieve dying patients of pain and suffering.

　　最高法庭關(guān)于醫(yī)生協(xié)助病人結(jié)束生命問題的裁決，對于如何用藥物減輕病危者的痛苦這個問題來說，具有重要的意義。

　　2、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.

　　盡管裁決認(rèn)為，憲法沒有賦予醫(yī)生幫助病人自殺的權(quán)利，然而最高法庭實際上卻認(rèn)可了醫(yī)療界的“雙效”原則，這個存在了好幾個世紀(jì)的道德原則認(rèn)為，如果某種行為具有雙重效果(希望達(dá)到的好效果和可以預(yù)見得到的壞效果)，那么，只要行為實施只是想達(dá)到好的效果，這個行為就是可以允許的。

　　3、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."

　　近年來，醫(yī)生們一直在借用這項原則，為自己替病危患者注射大劑量的嗎啡鎮(zhèn)痛的做法提供正當(dāng)?shù)睦碛桑�盡管他們知道，不斷增加的劑量最終會殺死病人。蒙特非奧里醫(yī)療中心主任南希•都博勒認(rèn)為，這項原則將消除部分醫(yī)生的疑慮，這些醫(yī)生在此之前一直強(qiáng)烈地認(rèn)為，如果給病人充分的藥品來止痛會加速他們的死亡的話那就不能這樣做。

　　4、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."

　　波士頓大學(xué)健康法律系主任喬治•安納斯堅持認(rèn)為，只要醫(yī)生是出于合理的醫(yī)療目的開藥，那么即使服用此藥會加速病人的死亡，醫(yī)生的行為也沒有違法。“這就像做手術(shù)，”他說，“我們不能稱那些死亡為殺人是因為醫(yī)生并沒有想殺死病人，盡管他們敢冒病人死亡的危險。假定你是一名醫(yī)生，只要你并沒有想讓病人自殺，你就可以去冒你的病人自殺的風(fēng)險。”

　　5、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.

　　另一方面，許多醫(yī)療界人士承認(rèn)，致使醫(yī)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，對這些病人來說，現(xiàn)代醫(yī)學(xué)延長了臨終前肉體的痛苦。

　　6、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.

　　就在最高法庭對醫(yī)助自殺進(jìn)行裁決的前三周，全國科學(xué)學(xué)會公布了一份長達(dá)兩卷的報告——臨近死亡：完善臨終護(hù)理。報告指出了醫(yī)院臨終關(guān)懷護(hù)理中存在的兩個問題：對病痛處理不力和大膽使用“無效而強(qiáng)制性的醫(yī)療程序，這些程序可能會延長死亡期，甚至?xí)�讓死亡期難堪”。

　　7、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.

　　醫(yī)療行業(yè)采取步驟，讓年輕醫(yī)生去晚期病人休養(yǎng)所培訓(xùn)，對各種大膽的鎮(zhèn)痛療法方面的知識進(jìn)行評估，為醫(yī)院護(hù)理制定一份符合美國醫(yī)療保障方案的付款條例，以及為評估和治療臨終痛苦制定新的標(biāo)準(zhǔn)。

　　8、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."

　　安納斯說，律師可以在要求把醫(yī)療界的這些善意的行為變成更好的護(hù)理行動方面發(fā)揮關(guān)鍵作用。“不少醫(yī)生對病人所遭受的毫無必要的，可預(yù)見的痛苦無動于衷”，乃至于已構(gòu)成“蓄意虐待病人”。他說，行醫(yī)資格理事會“必須明確表明——病人痛苦地死亡，可以推定，是由于醫(yī)生處理不力造成的，應(yīng)該因此吊銷其從醫(yī)資格”。

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