共用题干第二篇Double EffectThe Supreme Court's decisions on physician-assisted su...

问题共用题干第二篇

Double Effect

The Supreme Court's decisions on physician-assisted suicide carry important implications for how medi-
cine 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一a good one that is intended and a harmful one that is foreseen一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 termi-
nally 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 con-
trol 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 pa-
tient uses the drug to hasten death."It's like surgery,"he says."We don't call those deaths homicides be-
cause 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 under-treatment 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 li-
censing boards"must make it clear…that painful deaths are presumptively ones that are incompetently man-
aged and should result in license suspension."

选项 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

解析文章第一段说：最高法院对于医生协助病人自杀的裁决对如何使用药物来减轻病人的痛苦有着重大的意义。第二段说：尽管宪法没有赋予医生去帮助病人自杀的权力，法院实际支持率医疗界的“双效”原则。第三段说：医生们正是借用这个原则，为大剂量地给晚期（termi- nally ill)病人注射吗啡提供正当的理由，尽管增加剂量将最终致使病人于死亡。由此从第二段可推断出，B项：医生们帮助病人自杀仍是非法的，为正确答案。A项：医生过去常用增加剂量的方法来控制病人的痛苦，与第三段内容不符。C项：最高法院强烈反对医生帮助病人自杀，和D项：宪法没有赋予病人自杀的权力，都与文章内容不符。故选B。
文章第二段第一句说：法庭实际上认可了医疗界的“双效”原则。第三段又说，医疗界正是借用这个原则，为大剂量地给晚期病人注射吗啡提供正当的理由，尽管增加剂量将最终致使病人于死地。由此可知，法庭实际上同意给病人开大剂量的止痛药。这与C项意思相符。 A项：如果医生冒使病人致死的危险，将被认定有罪，与文章内容不符。B项：现代医学已经帮助晚期病人无痛康复，文中未提。D项：医生用药再也不会因为他的用药意图而被认为合理正当了，与文章内容不符。故选C。
由第七段中提到的“NAS的报告指出了医生临终护理存在着两个问题：一是治痛不力 (under-treatment of pain)，二是对无效且有强制性的医疗程序的大胆使用（the aggressive use of ineffectual and forced medical procedures)"，可知B项：对病痛治疗不力正确。
aggressive的意思有“咄咄逼人的，好斗的；攻击性的，侵略的；有闯劲的，大胆的”，根据上下文，aggressive在这里应为“大胆的”，所以选A。
在文章最后一段中，Annas指出：许多医生对病人所受的不必要的痛苦漠不关心，甚至到了“系统地虐待病人”的程度，并指出病人痛苦地死亡如果被认为是医生护理不力的后果，那就应吊销他们的行医执照。D项：延长病人不必要的痛苦为正确答案，因为Annas认为吊销医生执照的前提是病人痛苦地死亡。.

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