复旦研究生英语Unit Seven.docx

Doctors Dilemma: Treat or Let Die?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.特效药、冒险的手术、放疗以及重症监护等方面医学进步使成千上万人获得了新生。然而，对于多数人来说，现代医学成了一把双刃剑。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.医生可以用各式各样的太空时代的医疗技术治疗疾病，而病人康复的能力与之相比却相形见绌。可以治疗的疾病越来越多，而对于许多病人而言，康复的希望非常渺茫。甚至生死之间的界限也变得模糊不清了。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.许多美国人像韩国拳击手金得九一样身陷医学困境。金得九在一次比赛中遭到重击，不 省人事，大脑停止运转，仅靠人工方法延续生命。后经家人同意，拉斯维加斯的医生中断维 持生命的医疗器械，死神接踵而至。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.医学的最终目标是生存呢？还是生命的质量？在医学技术取得进步的背景下，全国的医 院和养老院围绕这个问题展开了一场激烈的辩论。“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?”“这个问题归根结底在于医学的本质是什么。”位于纽约哈得孙河畔黑斯挺斯的社会、伦理及生命科学研究所的所长丹尼尔卡拉汉说。“是挽救生命呢？还是为了病人的幸福？”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.医生、病人和亲戚，通常还有法庭都不得不做出艰难的医疗选择。这些艰难的伦理问题 通常出现于生命的两个顶端：处于生命开端的重病新生儿以及处于生命末端的临终病人。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.这种现代医学技术带来的两难问题催生了一个不断成长的新学科：生物伦理学。在全国127 家医学院中，有许多现在已经开设了医学伦理学课程。而仅仅在10 年前，这个领域实 际上是被忽视的。许多医院员工队伍中都出现了牧师、哲学家、 心理专家以及社会工作者来帮助病人做出重要的决定。二十个机构中就有一家成立特别伦理委员会来帮助解决棘手的确案例。Death and Dying死亡与垂危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.在所有重症监护病房的生命垂危的病人中，大约有20% 需要艰难的伦理抉择：是继续挽 救生命呢？还是放手不管听天由命？在癌症病房，每周涉及到生死抉择的病例多达三次。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.就连死亡的定义都已经发生了变化。由于人工心肺机可以取代心肺的呼吸和泵血功能，因而死亡也不再是“最后一口气 ”或心脏停止跳动。三十一个州和哥伦比亚特区已经通过脑死34超过12 个州承认“前遗嘱 ”。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, with its emphasis on providing comfort - not cure - to the dying patient, has gained momentum in many areas.病人“生前遗嘱 ”要求医生在疾病治愈无望的情况下不要通过静脉注射或其他方法延长生命。1979 年对加利福尼亚的医生所做的调查显示，当年有20%到 30%的医生遵从了病人的生前遗嘱。与此同时，一项强调为临终病人提供安适生活而不 是医疗服务的临终安养运动在许多地区得到了蓬勃发展。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.尽管社会对于死亡及生命垂危的理解取得了巨大进步，但是棘手的问题仍然迟迟不能解 决。例如：一位87 岁高龄的老太太，患有帕金森病而神经系统紊乱。突然有一天，她严重中风，家人发现她不省人事。他们可以做出的选择是，要么把她送到一家养老院，直到她离开人世，要么把她送去进行诊断和治疗。家人最后选择了纽约的一家教学医院。检验显示， 患者的中风是由一个血栓引起的，用手术可以治愈。手术之后，她对家人说：“你们为什么 还要让我回来重新受这种罪呢？”她的健康每况愈下，两年后溘然长逝。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.另一方面，医生说，预断通常不可靠，不能仅仅因为病人老了，残疾了，就放弃治疗。 伦理学家也担心，打着医学决定的幌子，死亡变得太容易，促使国家接受安乐死。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 thank God, Jims out of his misery. I hate to think it had to be done the way it was done, but I understand it. ”对于一些人来说，看着家人依靠高科技走向生命尽头的痛苦难以承受。今年早些时候， 德克萨斯州波提特的退休挤奶工Woodrow Wilson Collums 因对自己的哥哥吉姆实施安乐死而获得缓刑。吉姆患有严重的早老性痴呆症，在养老院在病床上卧床不起。事后，死者的遗 孀说道：“谢天谢地，吉姆终于摆脱。用这样的方法结束他的生命，我想都不愿想。但是，我非常理解。”Crisis in Newborn Care新生儿医学危机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. 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.在生命的另一端，科学技术给新生儿护理带来了一次重大革命，什么时候人类生命可以在子宫外存活已经无法确定。二十五年前，体重在3.5 磅以下的婴儿很少成活，而现在的成 活率高达70%。医生们正在尽力“拯救 ”一些体重只有1.5 磅的婴儿。治疗脊柱裂之类的新生 儿畸形病方面已经取得了巨大进展。大动脉转位是一种新生儿中非常常见的先天性心脏缺陷。就在10 年前，患有这种病的新生儿中只有5% 能够存活下来。而如今50%都可以幸免于难。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.但是，对于许多靠医学进步获得新生的婴儿来说，他们的生存付出了巨大的代价。许多 婴儿患有永久性生理或心理残疾。 “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.”“对于身患重症的新生儿是否实施治疗并不是一个简单的问题。”黑斯廷斯中心的托玛 斯默里说。 “但是，我坚持认为，痴呆或者有缺陷并不能构成任凭一个婴儿死去的理由。”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 form 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.但是，对于许多家长而言，生下一个有缺陷的新生儿是一场挥之不去的梦魇。两年前，亚特兰大一位母亲生下了一个患有唐氏综合症的婴儿。这是一种智力痴呆病。这个孩子同时患有结肠。家长恳请不要做手术，但是遭到了医生拒绝。如今，这个严重痴呆的孩子同时还患有结肠病。 “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?”“梅兰妮每次大便都会大呼小叫，”她妈妈解释说。“她生活无法自理，我们也不会与她永 世相伴。 我想帮助她摆脱痛苦和折磨。我不明白为什么要不惜一切代价地强调生命，我对医 生和医院感到愤怒。我们认为，不采取任何措施挽救她的生命对于她是最好的选择。医生们 的做法违背了自然法则。他们威胁说， 如果我们不配合他们的工作就把我们告到法院。我现在质问这些医生：,我们死后谁来照顾梅兰妮？那时你们这些医生都在哪里？”Changing Standards改变标准19. 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.现代科学技术所带来的选择对于医学工作产生了深刻的影响。直到现在，大多数医生都积极工作，运用自己所掌握的一切医学手段治疗疾病。医生所要解决的问题不仅是谁应该得到治疗而且还包括什么时候停止治疗。当前的趋势是终止治疗。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.这种情况的背后常会有承担法律责任的威胁。8月，两位加利福尼亚医生受到了谋杀指控。据说，他们切断了呼吸机，停止喂食喂水，从而引导一位深度昏迷病人的死亡。1981 年，一位马萨诸塞州的护士被指控以大剂量的吗啡谋杀了一位癌症病人，但后来她被宣布无罪。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.许多医生感觉自己陷入了法律诉讼、政府的法律法规以及病患权利的重重包围之中。现 代的医学技术实际上限制了他们的选择能力。他们的行动更多是通过委员会进行决策。Public Policy 公共政策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.”近年来，关于医学伦理的辩论已经转向了国家政策的层面上。“我逐渐意识到，我们的资源并不是无限的，”华盛顿医疗中心的Lynch 医生说。“没有钱伦理就无从谈起。”Since 1972. Americans have enjoyed unlimited access to a taxpayer-supported, kidney dialysis program that offers life-prolonging therapy to all patients with kidney fail