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 modem 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.”
36. 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.
37. 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.
38. 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.
39. Which of the following best defines the word “aggressive" (line 3, paragraph 7) ?
[A]Bold. [B]Harmful. [C]Careless. [D]Desperate.
40. 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.
名师解析
36. From the first three paragraphs, we learn that 从前三段我们得知
[A] doctors used to increase drug dosages to control their patients’ pain.
医生过去常常增加药物剂量来控制病人的病痛。
[B] it is still illegal for doctors to help the dying end their lives.
医生帮助病危者结束生命仍然是违法的。
[C] the Supreme Court strongly opposes physician-assisted suicide.
最高法院强烈反对医助自杀。
[D] patients have no constitutional right to commit suicide.
病人没有宪法赋予的自杀权利。
【答案】 B
【考点】 事实细节题。
【分析】 本题针对第一到第三段的所有内容进行了测试，选项 [A] 的相关信息可以定位到第三段，但是文中说“近几年医生才用这个原则为自己的行为辩护”。文中无法得出“过去常常”的说法。选项 [B] 可以定位到第二段，文中提到“宪法没有赋予这样的权利”。所以可以说，本答案是正确的。选项 [C] 可以定位到第二段，但是法院是支持这样的做法的。至于 [D] ，显然是错的。
37. Which of the following statements is true according to the text?
根据文章，下面哪一个说法是正确的?
[A] Doctors will be held guilty if they risk their patients’ death.
如果医生冒病人生命的危险，他们将被判有罪。
[B] Modern medicine has assisted terminally ill patients in painless recovery.
现代医学已经帮助晚期病人进行无痛康复。
[C] The Court ruled that high-dosage pain-relieving medication can be prescribed.
法院判决，医生可以开大剂量的镇疼药。
[D] A doctor's medication is no longer justified by his intentions.
医生用药是否合法不再取决于他的意图。
【答案】 C
【考点】 事实细节题。
【分析】 由于本题属于事实细节判断题，所以只有对每一个选项都进行辨析。选项 [A] 可以定位到第五段“ Annas ”的话。话中提到“只要医生不是想杀死病人，那么他们的死亡就不能被称为谋杀”。因此可以判定 [A] 不正确。 [B] 说病危者的无痛康复，在文中没有提到康复问题。 [C] 可以从第二段中找到，高等法院认为只要医生是出于好意，则可以去做。因此可以得出 [C] 是正确的。 [D] 错误是因为事实上，医生的意图在对于行为是否合法上面是非常重要的。
38. According to the NAS’s report, one of the problems in end-of-life care is
根据国家科学院 (NAS) 的报告，临终护理存在的一个问题是
[A]prolonged medical procedures. 延长了的医疗过程。
[B]inadequate treatment of pain. 对病痛处理不力。
[C]systematic drug abuse. 一贯的药物滥用。
[D]insufficient hospital care. 医院护理不力。
【答案】 B
【考点】 事实细节题。
【分析】 本题可以定位到第七段的第二句话中的“ the undertreatment of pain ”以及“ the aggressive use of ‘ ineffectual and forced medical procedures that may prolong and even dishonor the period of dying ’”。一个是“对病人的疼痛治疗不力”。另外一个是“强行使用无效的治疗方法延长生命，使得病人的晚期失去尊严”。因此，这里的答案应该是 [C] 。
39. Which of the following best defines the word “ aggressive ” (Line 3, Paragraph 7) ?
以下哪一个单词最好的解释了单词“ aggressive ” ( 第七段第三行 ) 的意思?
[A]Bold. 大胆的。 [B]Harmful. 有害的。
[C]Careless. 粗心的。 [D]Desperate. 绝望的。
【答案】 A
【考点】 词义题。
【分析】 这个单词的所在句“ 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. ”中，说的是对病痛处理不力和大胆使用“无效而强制性的医疗程序，这些程序可能会延长死亡期，甚至会让死亡期难堪”。对这种医疗程序的使用必须是“ aggressive ”的，是一般的方法不会用的。所以这个单词的意思就是“ bold ”。
40. George Annas would probably agree that doctors should be punished if they
乔治 · 安纳斯可能认为医生应该受到惩罚，如果他们
[A]manage their patients incompetently. 不胜任地治疗病人。
[B]give patients more medicine than needed. 给病人的药物超量。
[C]reduce drug dosages for their patients. 为病人减药。
[D]prolong the needless suffering of the patients. 延长病人不必要的痛苦。
【答案】 D
【考点】 事实细节题。
【分析】 本题的答题依据是文章的最后一段。在这一段中，“ Annas ”对大量的医生置病人的痛苦于不顾，无端地延长病人不必要的痛苦这种行为提出了批评，认为这种行为构成了“虐待病人”，并认为这样的医生应该予以吊销行医执照。因此可以判断 [D] 选项是正确的。
难句解析 ：
1. 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.
【结构分析】 本句的基本结构是“ although ”引导的状语从句后面加一个主句。“ although ”从句中有一个“ that ”引导的宾语从句。本句的主句是“ the court supported the medical principle of ‘ double effect ’”，后面是一个对“ double effect ”进行说明的同位语。
2. 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. ”
【结构分析】 本句主语是“ Nancy Dubler ”，后面有一个修饰它的同位语，谓语是“ contends ”，后面有一个宾语从句，其中从句的宾语又有一个“ who ”引导的定语从句，而且从句中有一个“ if ”引导的假设状语从句。
3. 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.
【结构分析】 该句的主句是“ many acknowledge ”，后面的宾语从句中又有一个定语从句“ for whom modern medicine has prolonged the physical agony of dying ”来修饰前面的“ patients ”。
全文翻译：
最高法庭关于医助自杀的裁决，对于医学界如何寻求减轻病危者的痛苦和折磨这个问题来说，具有重要的意义。
尽管裁决认为，宪法没有赋予医生帮助病人自杀的权利，然而最高法庭实际上却认可了医疗界的“双效”原则，这个存在了好几个世纪的道德原则认为，如果某种行为具有双重效果——希望达到的好效果和可以预见得到的坏效果——如果行为人只是想达到好的效果，这个行为就是可以被允许的。
尽管不断增加的剂量最终会杀死病人，近年来，医生们一直在借用这项原则，为自己替病危患者注射大剂量的吗啡镇痛的做法提供辩护。
蒙特非奥里医疗中心主任南希 · 都博勒认为，这项原则将会保护部分医生，“因为这些医生直到现在都一直坚持认为，如果给病人大量的药品可能加速病人的死亡的话，他们就无法给病人足够的药来控制他们的疼痛。”
波士顿大学健康法律系主任乔治 · 安纳斯坚持认为，只要医生是出于合理的医疗目的开药，那么即使服用此药会加速病人的死亡，医生的行为也没有违法。“这就像做手术，”他说，“我们不能称那些死亡为谋杀是因为医生并没有想杀死病人，尽管他们敢冒病人死亡的危险。假定你是一名医生，只要你并没有想让病人自杀，你就可以去冒你的病人自杀的风险。”
另一层面上，许多医疗界人士承认，致使医助自杀这场争论升温的部分原因是由于病人们的绝望情绪，对这些病人来说，现代医学延长了临终前肉体的痛苦。
就在最高法庭对医助自杀进行裁决的前三周，全国科学学会公布了一份长达两卷的报告《临近死亡：完善临终护理》。报告指出了医院临终关怀护理中存在的两个问题：对病痛处理不力和大胆使用“无效而强制性的医疗程序，这些程序可能会延长死亡期，甚至会让病人在死亡期中尊严受到伤害”。
医疗行业正在采取行动，使得年轻医生去晚期病人休养所培训，对各种大胆的镇痛疗法方面的知识进行测试，为医院护理制定一份符合美国医疗保障方案的付款条例，以及为评估和治疗临终痛苦制定新的标准。
安纳斯说，律师可以在要求把医疗界的这些善意的行为变成更好的护理行动方面发挥关键作用。“不少医生对病人所遭受的毫无必要的，可预见的痛苦无动于衷”，乃至于已构成“蓄意虐待病人”。他说，行医资格理事会“必须明确表明——病人痛苦地死亡，可以推定，是医生管理死亡病人不能胜任的表现，应该据此吊销其营业执照。”
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