研究生公共英语教材阅读B第3、4、10、11、14课文原文及翻译.doc

Unite 3 Doctors Dilemma: Treat or Let Die?Abigail Trafford1. Medical advances in wonder drugs, daring surgical procedures, radiation therapies, and intensive-care units have brought new life to thousands of people. Yet to many of them, modern medicine has become a double-edged sword.2. Doctors power to treat with an array of space-age techniques has outstripped the bodys capacity to heal. More medical problems can be treated, but for many patients, there is little hope of recovery. Even the fundamental distinction between life and death has been blurred.3. Many Americans are caught in medical limbo, as was the South Korean boxer Duk Koo Kim, who was kept alive by artificial means after he had been knocked unconscious in a fight and his brain ceased to function. With the permission of his family, doctors in Las Vegas disconnected the life-support machines and death quickly followed.4. In the wake of technologys advances in medicine, a heated debate is taking place in hospitals and nursing homes across the country - over whether survival or quality of life is the paramount goal of medicine.5. “It gets down to what medicine is all about, ” says Daniel Callahan, director of the Institute of Society, Ethics, and the Life Sciences in Hastings-on-Hudson, New York. “Is it really to save a life? Or is the larger goal the welfare of the patient?”6. Doctors, patients, relatives, and often the courts are being forced to make hard choices in medicine. Most often it is at the two extremes of life that these difficulty ethical questions arise - at the beginning for the very sick newborn and at the end for the dying patient.7. The dilemma posed by modern medical technology has created the growing new discipline or bioethics. Many of the countrys 127 medical schools now offer courses in medical ethics, a field virtually ignored only a decade ago. Many hospitals have chaplains, philosophers, psychiatrists, and social workers on the staff to help patients make crucial decisions, and one in twenty institutions has a special ethics committee to resolve difficult cases.Death and Dying8. Of all the patients in intensive-care units who are at risk of dying, some 20 percent present difficult ethical choices - whether to keep trying to save the life or to pull back and let the patient die. In many units, decisions regarding life-sustaining care are made about three times a week.9. Even the definition of death has been changed. Now that the heart-lung machine can take over the functions of breathing and pumping blood, death no longer always comes with the patients “last gasp” or when the heart stops beating. Thirty-one states and the District of Columbia have passed brain-death statutes that identify death as when the whole brain ceases to function.10. More than a dozen states recognize “living wills” in which the patients leave instructions to doctors not to prolong life by feeding them intravenously or by other methods if their illness becomes hopeless. A survey of California doctors showed that 20 to 30 percent were following instructions of such wills. Meanwhile, the hospice movement, which its emphasis on providing comfort - not cure - to the dying patient, has gained momentum in many areas.11. Despite progress in societys understanding of death and dying, theory issues remain. Example: A woman, 87, afflicted by the nervous-system disorder of Parkinsons disease, has a massive stroke and is found unconscious by her family. Their choices are to put her in a nursing home until she dies or to send her to a medical center for diagnosis and possible treatment. The family opts for a teaching hospital in New York city. Tests show the womans stroke resulted from a blood clot that is curable with surgery. After the operation, she says to her family: “Why did you bring me back to this agony?” Her health continues to worsen, and two years later she dies.12. On the other hand, doctors say prognosis is often uncertain and that patients, just because they are old and disabled, should not be denied life-saving therapy. Ethicists also fear that under the guise of medical decision not to treat certain patients, death may become too easy, pushing the country toward the acceptance of euthanasia.13. For some people, the agony of watching high-technology dying is too great. Earlier this year, Woodrow Wilson Collums, a retired dairyman from Poteet, Texas, was put on probation for the mercy killing of his older brother Jim, who lay hopeless in his bed at a nursing home, a victim of severe senility resulting from Alzheimers disease. After the killing, the victims widow said: “I think God, Jims out of his misery. I hate to think it had to be done the way it was done, but I understand it. ”Crisis in Newborn Care14. At the other end of the life span, technology has so revolutionized newborn care that it is no longer clear when human life is viable outside the womb. Newborn care has got huge progress, so it is absolutely clear that human being can survive independently outside the womb. Twenty-five years ago, infants weighting less than three and one-half pounds rarely survived. The current survival rate is 70 percent, and doctors are “salvaging” some babies that weigh only one and one-half pounds. Tremendous progress has been made in treating birth deformities such as spina bifida. Just ten years ago, only 5 percent of infants with transposition of the great arteries - the congenital heart defect most commonly found in newborns - survived. Today, 50 percent live.15. Yet, for many infants who owe their lives to new medical advances, survival has come at a price. A significant number emerge with permanent physical and mental handicaps.16. “The question of treatment and nontreatment of seriously ill newborns is not a single one,” says Thomas Murray of the Hastings Center. “But I feel strongly that retardation or the fact that someone is going to be less than perfect is not good grounds for allowing an infant to die.”17. For many parents, however, the experience of having a sick newborn becomes a lingering nightmare. Two years ago, an Atlanta mother gave birth to a baby suffering from Downs Syndrome, a form of mental retardation; the child also had blocked intestines. The doctors rejected the parents plea not to operate, and today the child, severely retarded, still suffers intestinal problems.18. “Every time Melanie has a bowel movement, she cries,” explains her mother. “Shes not able to take care of herself, and we wont live forever. I wanted to save her from sorrow, pain, and suffering. I dont understand the emphasis on life at all costs, and Im very angry at the doctors and the hospital. Who will take care of Melanie after were gone? Where will you doctors be then?”Changing Standards19. The choices posed by modern technology have profoundly changed the practice of medicine. Until now, most doctors have been activists, trained to use all the tools in their medical arsenals to treat disease. The current trend is toward nontreatment as doctors grapple with questions not just of who should get care but when to take therapy away.20. Always in the background is the threat of legal action. In August, two California doctors were charged with murdering a comatose patient by allegedly disconnecting the respirator and cutting off food and water. In 1981, a Massachusetts nurse was charged with murdering a cancer patient with massive doses of morphine but was subsequently acquitted.21. Between lawsuits, government regulations, and patients rights, many doctors feel they are under siege. Modern technology actually has limited their ability to make choices. More recently, these actions are resolved by committees.Public Policy22. In recent years, the debate on medical ethics has moved to the level of national policy. “Its just beginning to hit us that we dont have unlimited resources,” says Washington Hospital Centers Dr. Lynch. “You cant talk about ethics without talking ethics without talking about money.”23. Since 1972. Americans have enjoyed unlimited access to a taxpayer-supported, kidney dialysis program that offers life-prolonging therapy to all patients with kidney failure. To a number of police analysts, the program has grown out of control - to a $1.4billion operation supporting 61,000 patients. The majority are over 50, and about a quarter have other illness, such as cancer or heart disease, conditions that could exclude them from dialysis in other countries.24. Some hospitals are pulling back from certain lifesaving treatment. Massachusetts General Hospital, for example, has decided not perform heart transplants on the ground that the high costs of providing such surgery help too few patients. Burn units - through extremely effective - also provide very expensive therapy for very few patients.25. As medical scientists push back the frontiers of therapy, the moral dilemma will continue to grow for doctors and patients alike, making the choice of to treat the basic question in modern medicine.1. 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。然而，对于他们中不少人而言，现代医学已成为一把双刃剑。 2. 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界定清楚。 3. 不少美国人身陷医学囹圄，形同南韩拳击手金得九（Duk Koo Kim）的境遇。金得九在一次打斗中受到重击，人事不省，大脑停止运转，只能依靠人为方法赖以存活。经其家人允许，拉斯维加斯的医生切断了维持其生命的器械，死神便接踵而来。 4. 医疗技术进步了，是力求生存还是注重生命质量，哪个目标更为重要，这一问题在全美的医院和疗养院里引发了激烈的争论。 5. “归根结底，问题在于，医疗的宗旨是什么？”位于纽约哈德逊河上黑斯廷斯的社会、伦理及生命科学学会主席丹尼尔卡拉汉说，“是真的要挽救生命还是要为病人谋取更大的利益？” 6. 医生、病患、家属，通常还有法庭都不得不在医疗方面作出艰难的抉择。而这些道德难题往往最容易产生于生命的两个极端生命开初的重病新生儿和生命终端的垂死病患。 7. 这些因现代医学技术而产生的两难问题已不断催生出生物伦理学的新准则。如今，全美 127 家医学院中已有不少机构开设了医学伦理学课程，要在十年前，根本没人会去注意这个领域。不少医院的员工队伍都包含了牧师、哲学家、精神病医师以及社会工作者，以求帮助病人作出关键性抉择，而有二十分之一的机构专门成立了伦理委员会解决这些难题。 8. 在所有特护病房的垂死病人当中，有约莫 20%的病例，其当事人面临艰难的道德抉择是继续尽力挽救生命还是改变初衷、听凭病患死去。对于是否要维持生命的治疗，不少病房每周大约要作三次决定。 9. 现在就连死亡的定义也已经改变。既然人工心肺机能够代替心肺维持人的呼吸和血液循环，死神往往不会随着病患的“最后一丝喘息”或是心脏停止跳动而如期而至。因此，哥伦比亚特区以及美国三十一个州已经通过了脑死亡法，将死亡界定为“大脑停止运转”。 10. 十几个州认可病患的“生存意愿”，即病患指示医生，如果病症医治无望则通过静脉注射或其他方式中止其生命。针对加州医生的一项调查表明，20%到 30%的医生遵循这样的意愿。与此同时，一项重在为晚期病人提供临终关怀而非救治的安养活动在许多地区颇有发展势头。 11. 尽管社会对于生死的理解有所进步，棘手的问题仍然存在。例如：一位 87岁的老妪因受帕金森氏病神经系统紊乱病痛的折磨，严重中风，家人发现她已昏迷不醒。他们需作出决定：是将她安置在疗养院直至去世，还是将其送往医疗中心进行诊断、尽力救治。其家人选择了纽约城的一家教学医院。经检查发现，中风是由血管中的凝块引起的，可通过手术进行治疗。术后，她苏醒过来，却对自己的家人说：“你们为什么要将我带回痛苦的深渊？”她的健康状况每况愈下，两年后便告别人世。 12. 另一方面，医生们表明，仅仅根据症状就对疾病结果作出预测往往是不确定的，而病患如果只是年老或是伤残的话，就应该给予挽救生命的治疗。伦理学家也担心，有了对某些特定疾病不予治疗的决定做幌子，死亡可能会变得太容易了，会将整个国家推至接受安乐死的境地。 13. 对于某些人而言，看见别人依赖高科技术维持生命是极端痛苦的。今年早些时候，一位来自德州波提特从事乳品加工的退休工人伍德罗威尔逊科勒姆因对其兄长吉姆实施了安乐死而被判缓刑。吉姆不幸患有早老性痴呆症，昏聩糊涂的他只能无助地躺在疗养院的床上。在病患安乐死之后，他的遗孀说：“我感谢上帝，吉姆脱离了苦海。想到不得不用这种方式结束他的生命，我就特别难受，可我对此表示理解。” 14. 新生儿治疗危机在生命中的另一端，科技发展变革了新生儿救治技术，我们也不清楚人的生命何时可以在子宫外得以存活。二十五年前，体重不足 3.5 磅的婴儿几乎难以存活。如今的存活率竟然高达 70%，而且医生们还要“抢救”体重仅有 1.5 磅重的婴儿。在治疗诸如脊柱裂之类的新生儿畸形方面已经取得了重大进展。就在十年前，只有 5%患有大动脉转位的新生儿可以存活下来该病为新生儿最为常见的先天性心脏缺陷。而如今，该病的存活率却高达 50%。 15. 不过对于那些借助医学新进展而得以存活的婴儿而言，存活是要付出代价的。许多存活者都患有永久性的生理或心理残疾。 16. “对于重病新生儿进行治疗还是放弃治疗，这不是一个单纯的问题。”黑斯廷斯中心的托马斯默里说，“但我坚持认为，那种智力迟钝、有缺陷不足以成为任由一个婴儿死亡的理据。” 17. 然而，对于许多父母而言，养育患病新生儿的经历已成为挥之不去的噩梦。两年前，一位亚特兰大的母亲生下一个身患唐氏综合征的婴儿；这个孩子还患了结肠。医生们拒绝了家长不实施手术的恳求，而如今这个孩子，严重智力痴呆，仍然饱受肠病折磨。 18. “每次梅勒妮腹泻的时候，她会嚎啕大哭，”其母亲解释说。“她生活不能自理，而我们总不能长生不死照顾她一辈子吧。我想将她从苦痛折磨中解救出来。我不明白为什么要不惜一切代价地强调活命。对医生和医院的做法我真是气坏了。我们觉得，不再维持她的生命对她而言是最好的解脱。那些医生有悖常理。我质问那些出言威胁如果反对其实施手术就会把我们送上法庭的医生：我们死后谁来照顾梅勒妮？那时候你们这些医生会在哪里？” 19. 改变准则现代技术为人们提供了选择，进而从根本上改变了医疗的惯常做法。时至今日，大多数的医生都比较激进，他们训练有素，动用一切医疗器械医治疾病。如今，医生们需要解决的问题不仅仅是谁应该接受治疗，还包括应该何时终止治疗，这引发了不予治疗的趋向。 20. 往往来自法律的威胁也是导致这种趋向的原因。八月份，两位加州医生被控谋杀了一名昏迷不醒的病人，据说他们切断了呼吸器，停止了病患的食物水源供应。1981 年，一位马萨诸塞州的护士被控为一名癌症病人注射大量吗啡致其死亡，而此后她被宣告无罪。 21. 不少医生深感自己身陷诉讼案件、政府法规和病患权益的交相围困当中。现代技术的确禁锢了他们的决策能力。最近几年，这些诉讼裁决均交由委员会解决。 22. 公众措施最近几年，关于医疗伦理规范的争执已经上升到了国家政策的层次。“这才让我们幡然醒悟，我们没有取之不尽的资源。”华盛顿医院中心的医生林奇说，“说到伦理道德，就自然要谈到钱。” 23. 自 1972 年以来，美国肾衰竭患者均可以参与由纳税人所支持的肾透析治疗项目，该项目为所有肾衰竭病患提供了延续生命的疗法。许多政策分析员认为，该计划已经失控它亟需14亿美元的资金来支持6万 1千名病患。大多数病患都年逾五十，而约莫四分之一的人患有诸如癌症或是心脏病之类的其他疾病，有这种情况的病人在别的国家是不可能做肾透析的。 24. 一些医院正在撤销某些挽救生命的治疗项目。比方说，马萨诸塞州总医院已经决定不再实施心脏移植手术，理由是此类手术所需费用高昂，受助的病患寥寥无几。烧伤诊治病房尽管成效尤为显著也只能对极少的病人提供昂贵的治疗。 25. 当医学家正在向治疗的尖端领域推进之时，医生和病患等相关人士仍将面临越来越多的道德两难境地，致使继续治疗还是放弃治疗的抉择成为现代医学的一个基本问题。Unit 4 The Cultural Patterning of Space Joan Y Gregg1. Space is perceived differently in different cultures. Spatial consciousness in many Western cultures is based on a perception of objects in space, rather than of space itself. Westerners perceive shapes and dimensions, in which space is a realm of light, color, sight, and touch. Benjamin L. Whorf, and his classic work Language, Thought and Reality, offers the following explanation as one reason why Westerners perceive space in this manner. Western thought and language mainly developed from the Roman, Latin-speaking culture, which was a practical, experience-based system. Western culture has generally followed Roman thought patterns in viewing objective “reality” as the foundation for subjective or “inner” experience. It was only when the intellectually crude Roman culture became influenced by the abstract thinking of Greek culture that the Latin language developed a significant vocabulary of abstract, nonspatial terms. But the early Roman-Latin element of spatial consciousness, of concreteness, has been maintained in Western thought and language patterns, even though the Greek capacity for abstract thinking and expression was also inherited.2. However, some cultural-linguistic systems developed in the opposite direction, that is, from an abstract and subjective vocabulary to a more concrete one. For example, Whorf tells us that in the Hopi language the word heart, a concrete term, can be shown to be a late formation from the abstract terms think or remember. Similarly, although it seems to Westerners, and especially to Americans, that objective, tangible “reality” must precede any subjective or inner experience, in fact many Asian and other non-European cultures view inner experience as the basis for ones perceptions of physical reality. Thus although Americans are taught to perceive and react to the arrangement of objects in space and to think of space as being “wasted” unless it is filled with objects, the Japanese are trained to give meaning to space itself and to value “empty” space. For example, in many of their arts such as painting, garden design, and floral arrangements, the chief quality of composition is that essence of beauty the Japanese call shibumi. A painting that shows everything instead of leaving something unsaid is without shibumi. The Japanese artist will often represent the entire sky with one brush stroke or a distant mountain with one simple contour linethis is shibumi. To the Western eye, however, the large areas of “empty” space in such paintings make them look incomplete.3. It is not only the East and the West that are different in their patterning of space. We can also see cross-cultural varieties of spatial perception when we look at arrangements of urban space in different Western cultures. For instance, in the United States, cities are usually laid out along a grid, with the axes generally north/south and east/west. Streets and buildings are numbered sequentially. This arrangement, of course, makes perfect sense to Americans. When Americans walk in a city like Paris, which is laid out with the main streets radiating from centers, they often get lost. Furthermore, streets in Paris are named, not numbered, and the names often change after a few blocks. It is amazing to Americans how anyone gets around, yet Parisians seem to do well. Edward Hall, in The Silent Language, suggests that the layout of space characteristic of French cities is only one aspect of the theme of centralization that characterizes French culture. Thus Paris is the center of France, French government and educational systems are highly centralized, and in French offices the most important person has his or her desk in the middle of the office.4. Another aspect of the cultural patterning of space concerns he functions of spaces. In middle-class America, specific spaces are designated for specific activities. Any intrusion of one activity into a space that it was not designed for is immediately felt as inappropriate. In contrast, in Japan, this is not true: walls are movable, and rooms are used for one purpose during the day and another purpose in the evening and at night. In India there is yet another culturally patterned use of space. The function of space in India, both in public and in private places, is connected with concepts of superiority and inferiority. In Indian cities, villages, and even within the home, certain spaces are designated as polluted, or inferior, because of the activities that take place there and the kinds of people who use such space. Spaces in India are segregated so that high caste and low caste, males and females, secular and sacred activities are kept apart. This pattern has been used for thousands of years, as demonstrated by the archaeological evidence uncovered in ancient Indian cities. It is a remarkably persistent pattern, even in modern India, where public transportation reserves a separate space for women. For example, Chandigarh is a modern Indian city designed by a French architect. The apartments were built according to European concepts, but the Indians living there found certain aspects inconsistent with their previous use of living space. Ruth Freed, an anthropologist who worked in India, found that Indian families living in Chandigarh modified their apartments by using curtains to separate the mens and womens spaces. The families also continued to eat in the kitchen, a traditional pattern, and the living/dining room was only used when Western guests were present. Traditional Indian village living takes place in an area surrounded by a wall. The courtyard gives privacy to each residence group. Chandigarh apartments, however, were built with large windows, reflecting the European value