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The Supreme Court'sdecisions on physician-assisted suicide carry important implications for howmedicine seeks to relieve dying patients of pain and suffering。
Although it ruled that there is no constitutional right tophysician-assisted suicide, the Court in effect supported the medical principleof "double effect", a centuries-old moral principle holding that anaction having two effects—a good one that is intended and a harmful one that is foreseen—is permissibleif the actor intends only the good effect。
Doctors have used that principle in recent years to justify usinghigh doses of morphine to control terminally ill patients' pain, even thoughincreasing dosages will eventually kill the patient。
Nancy Dubler, director of Montefiore Medical Center, contends thatthe principle will shield doctors who "until now have very, very stronglyinsisted that they could not give patients sufficient mediation to controltheir pain if that might hasten death."
George Annas, chair of the health law department at BostonUniversity, maintains that, as long as a doctor prescribes a drug for alegitimate medical purpose, the doctor has done nothing illegal even if thepatient 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 tokill 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 theirsuicide."
On another level, many in the medical community acknowledge thatthe assisted-suicide debate has been fueled in part by the despair of patientsfor whom modem medicine has prolonged the physical agony of dying。
Just three weeks before the Court's ruling on physician-assistedsuicide, the National Academy of Science (NAS) released a two-volume report,Approaching Death: Improving Care at the End of Life. It identifies theundertreatment of pain and the aggressive use of "ineffectual and forced medicalprocedures that may prolong and even dishonor the period of dying" as thetwin problems of end-of-life care。
The profession is taking steps to require young doctors to train inhospices, to test knowledge of aggressive pain management therapies, to developa Medicare billing code for hospital-based care, and to develop new standardsfor assessing and treating pain at the end of life。
Annas says lawyers can play a key role in insisting that thesewell-meaning medical initiatives translate into better care. “Largenumbers of physicians seem unconcerned with the pain their patients areneedlessly and predictably suffering, ”to the extent thatit constitutes “systematic patient abuse。” He says medicallicensing boards “must make it clear ... that painful deaths are presumptively onesthat 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 theirlives。
[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 thetext?
[A]Doctors will be held guilty if they risk their patients' death。
[B]Modern medicine has assisted terminally ill patients in painlessrecovery。
[C]The Court ruled that high-dosage pain-relieving medication canbe prescribed。
[D]A doctor's medication is no longer justified by his intentions。
38. According to the NAS's report, one of the problems inend-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 bepunished 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。
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