unit03doctordilemma.ppt

Doctors Dilemma: Treat or Doctors Dilemma: Treat or Let Die?Let Die? Abigail TraffordAbigail Trafford Background informationBackground information About About the the author:author: Abigail Abigail (/ (/ /) /) Trafford Trafford is is an an author, author, columnist columnist and and former former editor editor of of the the health health section section of of thethe Washington Washington PostPost. . She She hosts hosts “Health “Health Talk,” Talk,” an an online online talk talk show show on on . . Trafford Trafford is is the the author author of of Crazy Crazy Time: Time: Surviving Surviving Divorce Divorce and and Building Building a a New New Life Life (1982) (1982) and and My My Time: Time: Making the Most of the Rest of Your Life (2004).Making the Most of the Rest of Your Life (2004). Duk Duk Koo Koo Kim:Kim: (1959-1982) (1959-1982) a a South South Korean Korean boxer, boxer, who who died died after after losing losing a a lightweight lightweight title title fight fight in in a a brave brave display display of of will will and and courage courage against against popular popular champion champion Ray Ray “Boom “Boom Boom” Boom” Mancini. Mancini. This This fight fight fatally fatally injured injured Duk-Koo Duk-Koo Kim Kim in in 14th 14th round round of of a a boxing boxing match match on on November November 13, 13, 1982. 1982. Minutes Minutes after after the the fight fight was was over, over, Kim Kim collapsed collapsed into into a a coma coma ( (昏迷昏迷) ), , and and was was taken to a hospital. taken to a hospital. Emergency Emergency brain brain surgery surgery was was done done there there to to try try to to save save his his life, life, but but that that effort effort proved proved to to be be futile, futile, as as Kim Kim lost lost his his life life five five days days after after the the match, match, on on November November 18. 18. Following Following this this fight, fight, the the number number of of rounds rounds was was changed changed from from 15 15 to to 12.12. The The Hospice Hospice MovementMovement(临终关怀运动): : A A hospice hospice is is a a place place where where people people who who have have a a terminal terminal or or fatal fatal illness illness are are treated treated until until they they die. die. The The hospice hospice movement movement specializes specializes in in pain pain control control and and the the aim aim of of the the hospice hospice movement movement is is to to give give people people with with painful painful and and terminal terminal diseases diseases the the best best possible possible quality quality of of life. life. The The modern modern hospice hospice movement movement began began in in the the 1960s 1960s and and many many have have a a Christian Christian foundation. foundation. Although Although many many of of the the doctors doctors and and nurses nurses who who work work at at the the hospices hospices may may be be Christian, Christian, the the patients patients can can be be of of any any faith faith or of none. or of none. The The staff staff not not only only look look after after the the patients, patients, they they help help them them prepare prepare for for their their deaths deaths and and also also help help the the relatives relatives prepare prepare for for the the loss loss of of their their loved loved ones. ones. The The atmosphere atmosphere at at a a hospice hospice will will be be a a loving loving and and caring caring one, one, where where the the patients patients and and the the relatives relatives are are encouraged encouraged to to talk talk about about death death and and dying. dying. Hospices Hospices are are concerned concerned not not only only with with the the physical physical heath heath of of their their patients, patients, but but also also with with their their emotional, emotional, psychological psychological and spiritual health. and spiritual health. Parkinsons Parkinsons disease disease ( (帕金森氏病帕金森氏病) ): : a a disease disease of of the the nervous nervous system system which which causes causes the the muscles muscles to to become become stiff stiff and and the the body body to to shake, shake, and and which which gradually gradually gets gets worse worse as as a a person person gets gets older. older. The The disease disease was was first first discovered discovered and and its its symptoms symptoms documented documented in in 1817 1817 by by the the British British physician physician Dr. Dr. James James Parkinson. Parkinson. In In the the United United States, States, the the prevalence prevalence of of Parkinsons Parkinsons disease disease is is 1 1 per per 625 625 people, people, though though this this increases increases with with age, age, as as indicated by the mean onset of 55 years of age. indicated by the mean onset of 55 years of age. Alzheimers Alzheimers disease disease ( (阿耳茨海默氏病阿耳茨海默氏病) ): : a a serious serious disease, disease, especially especially affecting affecting older older people, people, that that prevents prevents the the brain brain from from functioning functioning normally normally and and causes causes loss loss of of memory, memory, loss loss of of ability ability to to speak speak clearly, clearly, etc. etc. The The symptoms symptoms of of the the disease disease as as a a distinct distinct nosologic nosologic entity entity were were first first identified identified by by Emil Emil Kraepelin, Kraepelin, and and the the characteristic characteristic neuropathology neuropathology was was first first observed observed by by Alois Alois Alzheimer Alzheimer in in 1906. 1906. In In this this sense, sense, the the disease disease was was co-discovered co-discovered by by Kraepelin Kraepelin and and Alzheimer, Alzheimer, who who worked in Kraepelins laboratory. worked in Kraepelins laboratory. Because Because of of the the overwhelming overwhelming importance importance Kraepelin Kraepelin attached attached to to finding finding the the neuropathological neuropathological basis basis of of psychiatric psychiatric disorders, disorders, Kraepelin Kraepelin made made the the generous generous decision decision that that the the disease disease would would bear bear Alzheimers Alzheimers name. name. 2-3% 2-3% of of persons persons aged aged 65 65 show show signs signs of of the the disease, disease, while while 25% 25% or or more more of of persons persons aged aged 85 85 have have symptoms symptoms of of Alzheimers Alzheimers and and an an even even greater greater number number have have some some of of the the pathological pathological hallmarks hallmarks ( (病理特征病理特征) ) of of the disease without the characteristic symptoms. the disease without the characteristic symptoms. The The proportion proportion of of persons persons with with Alzheimers Alzheimers begins begins to to decrease decrease after after age age 85 85 because because of of the the increased increased mortality mortality ( (死亡率死亡率) ) due due to to the the disease, disease, and and relatively relatively few few people people over over the the age age of of 100 100 have the disease.have the disease. spina spina bifida bifida ( (脊柱裂脊柱裂/ / / / ) ) : : a a serious serious condition condition in in which which a a persons persons spine spine does does not not develop develop correctly correctly before before they they are are born, born, so so that that their their spinal spinal cordcord ( ( 脊髓脊髓) ) is is not not protected. protected. Spina Spina bifida bifida results results in in varying varying degrees degrees of of paralysis, paralysis, absence absence of of skin skin sensation, sensation, incontinence, incontinence, and and spine spine and and limb limb problems problems depending depending on on the the severity severity and and location location of of the the lesion lesion damage damage on on the the spine. spine. In In very very rare rare cases, cases, cognitive cognitive problems problems also also result. result. Most Most babies babies born born with with the the condition condition will will need need surgeries surgeries to to correct correct spinal, spinal, foot foot or or leg leg problems, problems, shunt shunt surgery surgery to to drain drain fluid fluid from from the the brain, brain, application application of of techniques techniques to to control control bladder bladder and and bowel bowel function, function, and and braces braces and and other other equipment equipment to to assist assist in in walking. walking. In In the the United United States, States, spina spina bifida bifida occurs occurs in in about about one one in in every every 1-2,000 1-2,000 births.births. Downs Downs syndrome syndrome ( (唐氏综合征唐氏综合征) ): : a a condition condition which which some some people people are are born born with with and and which which means means they they have have lower lower than than average average mental mental ability, ability, a a flat flat face face and and nose, nose, and and sloping sloping eyes. eyes. Downs Downs syndrome syndrome encompasses encompasses a a number number of of genetic genetic disorders, disorders, of of which which trisomy trisomy 21 21 is is the the most most representative, representative, causing causing highly highly variable variable degrees degrees of of learning learning difficulties difficulties and and physical physical disabilities. disabilities. It It is is named named for for John John Langdon-Down, Langdon-Down, the the British British doctor doctor who who first first described described it. it. Incidence Incidence of of Down Down syndrome syndrome is is estimated estimated at at 1 1 per per 660 660 births, births, making making it it the the most most common common chromosomal chromosomal abnormality. abnormality. Maternal Maternal age age influences influences the the risk risk of of conceiving conceiving a a baby baby with with the the syndrome. syndrome. At At age age 20-24, 20-24, it it is is only only 1/1490, 1/1490, while while at at age age 40 40 it it is is 1/106 1/106 and and at at age age 49 49 it it is is 1/11. 1/11. Introduction to the textIntroduction to the text Human Human beings beings have have always always faced faced basic basic questions questions of of ethics. ethics. But But modern modern technology technology has has brought brought many many new new complications complications that that make make such such decisions decisions more more difficult difficult now. now. This This is is especially especially true true in in medicine medicine where where the the ethical ethical decisions are matters of life and death. decisions are matters of life and death. The The wonders wonders of of modern modern medicine medicine dazzle dazzle us us daily daily as as we we read read about about new new discoveries discoveries and and lifesaving lifesaving techniques. techniques. SmallpoxSmallpox ( (天花天花) ), , one one of of the the ancient ancient scourges scourges of of humanity, humanity, has has now now been been virtually virtually eliminated. eliminated. Patients Patients whose whose kidneys kidneys have have ceased ceased to to function function live live on on thanks thanks to to the the recently recently invented invented dialysis dialysis (/ (/ / /血液透析血液透析) ) machine. machine. People People who who just just a a few few decades decades ago ago would would have have been been pronounced pronounced dead dead when when their their hearts hearts stopped stopped beating beating are are rushed rushed into into surgery surgery and and given given a a new new heart; many later return to normal life. heart; many later return to normal life. This This all all seems seems life life wonderful wonderful news, news, but but is is there there a a darker darker side side to to these these medical medical miracles? miracles? As As is is so so often often the the case, case, new new benefits benefits bring bring new new problems. problems. It It becomes becomes more more and and more more difficult difficult for for doctors, doctors, nurses, nurses, and and patients patients to to know know what what is is right right and and wrong wrong in in medicine. medicine. The The article article gives an overview of these complex questions.gives an overview of these complex questions. In In the the first first part part of of the the article article (para.17), (para.17), Abigail Abigail Trafford Trafford introduces introduces us us to to the the modern modern dilemma dilemma in in medicine: medicine: whether whether survival survival or or quality quality of of life life is is the the paramount paramount goal goal of of medicine, medicine, which which gives gives rise rise to to the the growing growing new new discipline discipline of of bioethics. bioethics. Most Most often, often, hard hard choices choices concerning concerning life life or or death death have have to to be be made made either either at at the the end end for for the the treatment treatment of of the the dying dying (para.813) (para.813) or or at at the the beginning beginning for for the the very sick newborn (para.1418).very sick newborn (para.1418). Doctors Doctors may may feel feel they they are are under under siege siege and and often often rely rely on on committees committees to to decide decide for for them them whether whether or or not not to to continue continue treatment treatment (para.1921). (para.1921). This This dilemma dilemma has has even even moved moved onto onto the the level level of of national national policy policy and and will will remain remain as as “the “the basic basic question in modern medicine” (para.2225).question in modern medicine” (para.2225). Text and language pointsText and language points 1. 1. Medical Medical advances advances in in wonder wonder drugs, drugs, daring daring surgical surgical procedures, procedures, radiation radiation therapies, therapies, and and intensive-care intensive-care units units have have brought brought new new life life to to thousands thousands of of people. people. Yet Yet to to many many of of them, them, modern modern medicine has become a double-edged sword.medicine has become a double-edged sword. 1. 1. 在特效药、风险性手术进程、放疗法以及特在特效药、风险性手术进程、放疗法以及特 护病房方面的医学进展已为数千人带来新生。护病房方面的医学进展已为数千人带来新生。 然而，对于他们中不少人而言，现代医学已成然而，对于他们中不少人而言，现代医学已成 为一把双刃剑。为一把双刃剑。 wonder wonder drugdrug:a :a very very good good and and effective effective new new medicine medicine 特效药特效药 radiation radiation therapy:therapy: the the treatment treatment of of an an illness illness or or injury injury by by heat, heat, light, light, or or elementary elementary particles particles over over a a fairly fairly long long period period of of time time 放射治疗；放射治疗； 放疗法放疗法 double-edged double-edged swordsword : : something something that that has has as as many many bad bad results results as as good good ones; ones; something something with with one negative and one positive effect one negative and one positive effect e.g. e.g. Being Being famous famous is is often often a a double-double- edged sword.edged sword. e.g. e.g. The The competition competition rules rules must must be be regarded regarded as as a a double-edged double-edged sword sword by by businesses.businesses. e.g. e.g. Throughout Throughout our our history, history, judicial judicial review has been a double-edged sword.review has been a double-edged sword. 2. 2. Doctors Doctors power power to to treat treat with with an an array array of of space-space- age age techniques techniques has has outstripped outstripped the the bodys bodys capacity capacity to to heal. heal. More More medical medical problems problems can can be be treated, treated, but but for for many many patients, patients, there there is is little little hope hope of of recovery. recovery. Even Even the the fundamental fundamental distinction distinction between life and death has been blurred.between life and death has been blurred. 2. 2. 医生采用一系列航空时代技术进行治疗的能力已医生采用一系列航空时代技术进行治疗的能力已 超过人体本身的治愈能力。从医学的角度来说，有更超过人体本身的治愈能力。从医学的角度来说，有更 多的疾病能够得以诊治，可对于许多病人而言，复原多的疾病能够得以诊治，可对于许多病人而言，复原 的希望却微乎其微。甚至生死之间的基本差别也难以的希望却微乎其微。甚至生死之间的基本差别也难以 界定清楚。界定清楚。 an an array array ofof: :a a group group of of people people or or things, things, especially one that is large or impressiveespecially one that is large or impressive e.g. e.g. There There was was a a glittering glittering array array of of film film stars at the festival.stars at the festival. e.g. e.g. There There was was a a vast vast array array of of colors colors to to choose from.choose from. e.g. e.g. They They sat sat before before an an array array of of microphones and cameras. microphones and cameras. outstrip:outstrip: v v .be .be greater greater in in quantity quantity than than something else; exceed or surpass something else; exceed or surpass 超过；超越超过；超越 e.g. e.g. The The demand demand for for food food outstripped outstripped the the supply. supply. e.g. e.g. Even Even the the most most primitive primitive computer computer can can outstrip outstrip the the human human brain brain in in certain certain types types of of calculation.calculation. e.g. e.g. Girls Girls are are now now outstripping outstripping boys boys in in all all school subjects. school subjects. blurblur . . v v . . to to make make the the difference difference between between two two ideas, subjects etc less clearideas, subjects etc less clear使使模糊不清模糊不清 e.g. e.g. His His novels novels tend tend to to blur blur the the distinctions between reality and fantasy. distinctions between reality and fantasy. e.g. e.g. The The difference difference between between male male and and female female roles roles within within the the house house has has become become blurred. blurred. e.g. e.g. The The show show blurs