复旦研究生综合英语2(修订版)-Unit.ppt

U8 AdditionallnformationfortheTeacher sReference TextActiveandPassiveEuthanasia Warm upActivities FurtherReading WritingSkills AdditionalWork Warm upActivities 1 Trytogiveadefinitionofeuthanasia 2 Brainstormabouttheprosandconsofeuthanasia 3 Collectreferencestothisissueandtakedownnotes 4 Orderinformationandworkoutyourownopinion Warm up1 1 JamesRachelswasanAmericanprofessorofmoralphilosophyandmedicalethicswhowasparticularlyconcernedwithethicalissues BorninColumbus Georgia heearneddegreesatMercerUniversityandtheUniversityofCaliforniabeforejoiningtheUniversityofAlabama BirminghamDepartmentofPhilosophyfacultyin1977 ThepopularityofhisgroundbreakingtextbookanthologyMoralProblems 1971 whichsold100 000copies influencedAmericanuniversitiestomoveawayfrommoretraditionalphilosophicallyorientedundergraduatemoralphilosophycoursestowardmorepracticalundergraduatecoursesinethics AIFTTR1 1 AdditionallnformationfortheTeacher sReference 1 JamesRachels 1941 2003 AIFTTR2 1 2 Euthanasia Euthanasiaisapracticeofmercifullyendingaperson slifeinordertoreleasethepersonfromanincurabledisease intolerablesuffering orundignifieddeath ThewordeuthanasiaderivesfromtheGreekfor gooddeath andoriginallyreferredtointentionalmercykilling Proponentsofeuthanasiabelievethatunnecessarilyprolonginglifeinterminallyillpatientscausessufferingtothepatientsandtheirfamilymembers Manysocietiesnowpermitpassiveeuthanasia whichallowsphysicianstowithholdorwithdrawlife sustainingtreatmentwhendirectedtodosobythepatientoranauthorizedrepresentative AIFTTR2 2 Euthanasiadiffersfromassistedsuicide inwhichapatientvoluntarilybringsabouthisorherowndeathwiththeassistanceofanotherperson typicallyaphysician Inthiscase theactisasuicide intentionalself inflicteddeath becausethepatientactuallycauseshisorherowndeath A RelatedLawsAslawshaveevolvedfromtheirtraditionalreligiousunderpinnings certainformsofeuthanasiahavebeenlegallyaccepted Ingeneral lawsattempttodrawalinebetweenpassiveeuthanasia generallyassociatedwithallowingapersontodie andactiveeuthanasia generallyassociatedwithkillingaperson Whilelawscommonlypermitpassiveeuthanasia activeeuthanasiaistypicallyprohibited AIFTTR2 3 LawsintheUnitedStatesandCanadamaintainthedistinctionbetweenpassiveandactiveeuthanasia Whileactiveeuthanasiaisprohibited courtsinbothcountrieshaveruledthatphysiciansshouldnotbelegallypunishediftheywithholdorwithdrawalife sustainingtreatmentattherequestofapatientorthepatient sauthorizedrepresentative Thesedecisionsarebasedonincreasingacceptanceofthedoctrinethatpatientspossessarighttorefusetreatment Untilthelate1970s whetherornotpatientspossessedalegalrightofrefusalwashighlydisputed Onefactorthatmayhavecontributedtogrowingacceptanceofthisrightistheabilitytokeepindividualsaliveforlongperiodsoftime evenwhentheyarepermanentlyunconsciousorseverelybrain damaged Proponentsjets AIFTTR2 4 oflegalizedeuthanasiabelievethatprolonginglifethroughtheuseofmoderntechnologicaladvances suchasrespiratorsandkidneymachines maycauseunwarrantedsufferingtothepatientandthefamily Astechnologyhasadvanced thelegalrightsofthepatienttoforgosuchtechnologicalinterventionhaveexpanded EveryU S statehasadoptedlawsthatauthorizelegallycompetentindividualstomakeadvanceddirectives oftenreferredtoaslivingwills Suchdocumentsallowindividualstocontrolsomefeaturesofthetimeandmanneroftheirdeaths Inparticular thesedirectivesempowerandinstructdoctorstowithholdlife supportsystemsiftheindividualsbecometerminallyill Furthermore thefederalPatientSelf DeterminationAct whichbecameeffectivein1991 requiresfederallycertifiedhealth carebet AIFTTR2 5 facilitiestonotifycompetentadultpatientsoftheirrighttoacceptorrefusemedicaltreatment Thefacilitiesmustalsoinformsuchpatientsoftheirrightsundertheapplicablestatelawtoformulateanadvanceddirective PatientsinCanadahavesimilarrightstorefuselife sustainingtreatmentsandformulateadvanceddirectives Asofmid 1999 onlyoneU S state Oregon hadenactedalawallowingphysicianstoactivelyassistpatientswhowishtoendtheirlives However Oregon slawconcernsassistedsuicideratherthanactiveeuthanasia Itauthorizesphysicianstoprescribelethalamountsofmedicationthatpatientsthenadministerthemselves Inresponsetomodernmedicaltechnology physiciansandlawmakersareslowlydevelopingnewprofessionalandlegaldefinitionsofdeath Additionally expertsareformulatingrulestobat AIFTTR2 6 implementthesedefinitionsinclinicalsituations forexample whenprocuringorgansfortransplantation Themajorityofstateshaveacceptedadefinitionofbraindeath thepointwhencertainpartsofthebrainceasetofunction asthetimewhenitislegaltoturnoffapatient slife supportsystem withpermissionfromthefamily In1995theNorthernTerritoryofAustraliabecamethefirstjurisdictiontoexplicitlylegalizevoluntaryactiveeuthanasia However thefederalparliamentofAustraliaoverturnedthelawin1997 In2001TheNetherlandsbecamethefirstcountrytolegalizeactiveeuthanasiaandassistedsuicide formalizingmedicalpracticesthatthegovernmenthadtoleratedforyears UndertheDutchlaw euthanasiaisjustified notlegallypunishable ifthemust AIFTTR2 7 physicianfollowsstrictguidelines Justifiedeuthanasiaoccursif 1 thepatientmakesavoluntary informed andstablerequest 2 thepatientissufferingunbearablywithnoprospectofimprovement 3 thephysicianconsultswithanotherphysician whointurnconcurswiththedecisiontohelpthepatientdie and 4 thephysicianperformingtheeuthanasiaprocedurecarefullyreviewsthepatient scondition Officialsestimatethatabout2percentofalldeathsinTheNetherlandseachyearoccurasaresultofeuthanasia B PrevalenceAlthoughestablishingtheactualprevalenceofactiveeuthanasiaisdifficult studiessuggestthatthepracticeisnotcommonintheUnitedStates Inastudypublishedin1998intheNewEnglandJournalofMedicine onlyabout6percentofbasketball physicianssurveyedreportedthattheyhadhelpedapatienthastenhisorherowndeathbyadministeringalethalinjectionorprescribingafataldoseofmedication Eighteenpercentoftherespondingphysiciansindicatedthattheyhadreceivedrequestsforsuchassistance However one fifthofthephysicianssurveyedindicatedthattheywouldbewillingtoassistpatientsifitwerelegaltodoso NocomparabledataareavailableforCanada However in1998theCanadianMedicalAssociation CMA proposedthatastudyofeuthanasiaandphysician assistedsuicidebeundertakenduetopoorinformationonthesubject C EthicalConcernsTheissueofeuthanasiaraisesethicalquestionsforphysiciansandotherhealth careproviders Theethicalcodeofphysiciansinthe AIFTTR2 8 AIFTTR2 9 UnitedStateshaslongbeenbasedinpartontheHippocraticOath whichrequiresphysicianstodonoharm However medicalethicsarerefinedovertimeasdefinitionsofharmchange Priortothe1970s therightofpatientstorefuselife sustainingtreatment passiveeuthanasia wascontroversial Asaresultofvariouscourtcases thisrightisnearlyuniversallyacknowledgedtoday evenamongconservativebioethicists seeMedicalEthics Thecontroversyoveractiveeuthanasiaremainsintense inpartbecauseofoppositionfromreligiousgroupsandmanymembersofthelegalandmedicalprofessions Opponentsofvoluntaryactiveeuthanasiaemphasizethathealth careprovidershaveprofessionalobligationsthatprohibitkilling Theseopponentsmaintainthatactiveeuthanasiaisinconsistentwiththerolesofnursing basketball AIFTTR2 10 caregiving andhealing Opponentsalsoarguethatpermittingphysicianstoengageinactiveeuthanasiacreatesintolerablerisksofabuseandmisuseofthepoweroverlifeanddeath Theyacknowledgethatparticularinstancesofactiveeuthanasiamaysometimesbemorallyjustified However opponentsarguethatsanctioningthepracticeofkillingwould onbalance causemoreharmthanbenefit Supportersofvoluntaryactiveeuthanasiamaintainthat incertaincases relieffromsuffering ratherthanpreservinglife shouldbetheprimaryobjectiveofhealth careproviders Theyarguethatsocietyisobligatedtoacknowledgetherightsofpatientsandtorespectthedecisionsofthosewhoelecteuthanasia Supportersofactiveeuthanasiacontendthatsincesocietyhasmutual AIFTTR2 11 acknowledgedapatient srighttopassiveeuthanasia forexample bylegallyrecognizingrefusaloflife sustainingtreatment activeeuthanasiashouldsimilarlybepermitted Whenarguingonbehalfoflegalizingactiveeuthanasia proponentsemphasizecircumstancesinwhichaconditionhasbecomeoverwhelminglyburdensomeforapatient painmanagementforthepatientisinadequate andonlyaphysicianseemscapableofbringingrelief Theyalsopointoutthatalmostanyindividualfreedominvolvessomeriskofabuseandarguethatsuchriskscanbekepttoaminimumbyusingproperlegalsafeguards AIFTTR3 1 3 AmericanMedicalAssociation TheAmericanMedicalAssociation AMA foundedin1847andincorporated1897 isthelargestassociationofphysiciansandmedicalstudentsintheUnitedStates Itisanonprofitprofessionalassociationofphysicians includingallmedicalspecialties TheAMA spurposeistopromotetheartandscienceofmedicineforthebettermentofthepublichealth toadvancetheinterestsofphysiciansandtheirpatients topromotepublichealth tolobbyforlegislationfavorabletophysiciansandpatients toraisemoneyformedicaleducationandtoserveasanadvocatefortheadvancementoftheprofession TheAssociationalsopublishestheJournaloftheAmericanMedicalAssociation JAMA whichhasthelargestcirculationofanyweeklymedicaljournalintheworld TheAMAalsopublishesalistofPhysicianSpecialtyCodeswhichareastandardmethodintheU S foridentifyingphysicianandpracticespecialties Text ActiveandPassiveEuthanasia Notes IntroductiontotheAuthorandtheArticle PhrasesandExpressions Exercises MainIdeaoftheText MainIdeaoftheText1 MainIdeaoftheText Rachels essay ActiveandPassiveEuthanasia firstappearedintheNewEnglandJournalofMedicinein1975 Init Rachelsarguesthatkillingisnotmorallyworsethanlettingapersondieofnaturalcauses whendoneforhumanitarianreasons Therefore activeeuthanasiaisnotanyworsethanpassiveeuthanasia andincaseswhereapatientissparedneedlesspain arguablybetter JamesRachels 1941 2003 wasanAmericanprofessorofmoralphilosophyandmedicalethicswhowasparticularlyconcernedwithethicalissues BorninColumbus Georgia heearneddegreesatMercerUniversityandtheUniversityofCaliforniabeforejoiningtheUniversityofAlabama BirminghamDepartmentofPhilosophyfacultyin1977 ThepopularityofhisgroundbreakingtextbookanthologyMoralProblems 1971 whichsold100 000copies influencedAmericanuniversitiestomoveawayfrommoretraditionalphilosophicallyorientedundergraduatemoralphilosophycoursestowardmorepracticalundergraduatecoursesinethics IntroductiontotheAuthorandthearticle IntroductiontotheAuthorandtheArticle Rachels essay ActiveandPassiveEuthanasia firstappearedintheNewEnglandJournalofMedicinein1975 Init Rachelsarguesthatkillingisnotmorallyworsethanlettingapersondieofnaturalcauses whendoneforhumanitarianreasons Therefore activeeuthanasiaisnotanyworsethanpassiveeuthanasia andincaseswhereapatientissparedneedlesspain arguablybetter IntroductiontotheAuthorandthearticle Part2 T1 Thedistinctionbetweenactiveandpassiveeuthanasiaisthoughttobecrucialformedicalethics Theideaisthatitispermissible atleastinsomecases towithholdtreatmentandallowapatienttodie butitisneverpermissibletotakeanydirectactiondesignedtokillthepatient Thisdoctrineseemstobeacceptedbymostdoctors anditisendorsedinastatementadoptedbytheAmericanMedicalAssociationonDecember4 1973 JamesRachels ActiveandPassiveEuthanasia Text Theintentionalterminationofthelifeofonehumanbeingbyanother mercykilling iscontrarytothatforwhichthemedicalprofessionstandsandiscontrarytothepolicyoftheAmericanMedicalAssociation Thecessationoftheemploymentofextraordinarymeanstoprolongthelifeofthebodywhenthereisirrefutableevidencethatbiologicaldeathisimminentisthedecisionofthepatientand orhisimmediatefamily Theadviceandjudgmentofthephysicianshouldbefreelyavailabletothepatientand orhisimmediatefamily Part2 T2 However astrongcasecanbemadeagainstthisdoctrine InwhatfollowsIwillsetoutsomeoftherelevantarguments andurgedoctorstoreconsidertheirviewsonthismatter Tobeginwithafamiliartypeofsituation apatientwhoisdyingofincurablecancerofthethroatisinterriblepain whichcannolongerbesatisfactorilyalleviated Heiscertaintodiewithinafewdays evenifpresenttreatmentiscontinued buthedoesnotwanttogoonlivingforthosedayssincethepainisunbearable Soheasksthedoctorforanendtoit andhisfamilyjoinsintherequest Part2 T3 Supposethedoctoragreestowithholdtreatment astheconventionaldoctrinesayshemay Thejustificationforhisdoingsoisthatthepatientisinterribleagony andsinceheisgoingtodieanyway itwouldbewrongtoprolonghissufferingneedlessly Butnownoticethis Ifonesimplywithholdstreatment itmaytakethepatientlongertodie andsohemaysuffermorethanhewouldifmoredirectactionweretakenandalethalinjectiongiven Thisfactprovidesastrongreasonforthinkingthat oncetheinitialdecisionnottoprolonghisagonyhasbeenmade activeeuthanasiaisactuallypreferabletopassiveeuthanasia ratherthanthereverse Tosayotherwiseistoendorsetheoptionthatleadstomoresufferingratherthanless andiscontrarytothehumanitarianimpulsethatpromptsthedecisionnottoprolonghislifeinthefirstplace Part2 T4 Partofmypointisthattheprocessofbeing allowedtodie canberelativelyslowandpainful whereasbeinggivenalethalinjectionisrelativelyquickandpainless Letmegiveadifferentsortofexample IntheUnitedStatesaboutonein600babiesisbornwithDown ssyndrome 1Mostofthesebabiesareotherwisehealthy thatis withonlytheusualpediatriccare theywillproceedtoanotherwisenormalinfancy Some however arebornwithcongenitaldefectssuchasintestinalobstructionthatrequireoperationsiftheyaretolive Sometimes theparentsandthedoctorwilldecidenottooperate andlettheinfantdie AnthonyShawdescribeswhathappensthen Part2 T5 Part2 T6 Whensurgeryisdenied thedoctor musttrytokeeptheinfantfromsufferingwhilenaturalforcessapthebaby slifeaway Asasurgeonwhosenaturalinclinationistousethescalpeltofightoffdeath standingbyandwatchingasalvageablebabydieisthemostemotionallyexhaustingexperienceIknow Itiseasyataconference inatheoreticaldiscussion todecidethatsuchinfantsshouldbeallowedtodie Itisaltogetherdifferenttostandbyinthenurseryandwatchasdehydrationandinfectionwitheratinybeingoverhoursanddays Thisisaterribleordealformeandthehospitalstaff muchworsesothanfortheparentswhoneversetfootinthenursery Part2 T7 Icanunderstandwhysomepeopleareopposedtoalleuthanasiaandinsistthatsuchinfantsmustbeallowedtolive IthinkIcanalsounderstandwhyotherpeoplefavordestroyingthesebabiesquicklyandpainlessly Butwhyshouldanyonefavorletting dehydrationandinfectionwitheratinybeingoverhoursanddays Thedoctrinethatsaysthatababymaybeallowedtodehydrateandwither butmaynotbegivenaninjectionthatwouldenditslifewithoutsuffering seemssopatentlycruelastorequirenofurtherrefutation Thestronglanguageisnotintendedtooffend butonlytoputthepointintheclearestpossibleway Mysecondargumentisthattheconventionaldoctrineleadstodecisionsconcerninglifeanddeathmadeonirrelevantgrounds Part2 T8 ConsideragainthecaseoftheinfantswithDown ssyndromewhoneedoperationsforcongenitaldefectsunrelatedtothesyndrometolive Sometimes thereisnooperation andthebabydies butwhenthereisnosuchdefect thebabyliveson Now anoperationsuchasthattoremoveanintestinalobstructionisnotprohibitivelydifficult Thereasonwhysuchoperationsarenotperformedinthesecasesis clearly thatthechildhasDowns syndromeandtheparentsanddoctorjudgethatbecauseofthefactitisbetterforthechildtodie Butnoticethatthissituationisabsurd nomatterwhatviewonetakesofthelivesandpotentialsofsuchbabies Ifthelifeofsuchaninfantisworthpreserving whatdoesitmatterifitneedsasimpleoperation Or ifonethinksitbetterthatsuchababyshouldnotliveon whatdifferencedoesitmakethatithappenstohaveanunobstructedintestinaltract Ineithercase thematteroflifeanddeathisbeingdecidedonirrelevantgrounds ItistheDown ssyndrome andnottheintestines thatistheissue Themattershouldbedecided ifatall onthatbasis andnotbeallowedtodependontheessentiallyirrelevantquestionofwhethertheintestinaltractisblocked Part2 T9 Whatmakesthissituationpossible ofcourse istheideathatwhenthereisanintestinalblockage onecan letthebabydie butwhenthereisnosuchdefectthereisnothingthatcanbedone foronemustnot kill it Thefactthatthisidealeadstosuchresultsasdecidinglifeordeathonirrelevantgroundsisanothergoodreasonwhythedoctrineshouldberejected Onereasonwhysomanypeoplethinkthatthereisanimportantmoraldifferencebetweenactiveandpassiveeuthanasiaisthattheythinkkillingsomeoneismorallyworsethanlettingsomeonedie Butisit Iskilling initself worsethanlettingdie Toinvestigatethisissue twocasesmaybeconsideredthatareexactlyalikeexceptthatoneinvolveskillingwhereastheother Part2 T10 Part2 T11 involveslettingsomeonedie Then itcanbeaskedwhetherthisdifferencemakesanydifferencetothemoralassessments Itisimportantthatthecasesbeexactlyalike exceptforthisonedifference sinceotherwiseonecannotbeconfidentthatitisthisdifferenceandnotsomeotherthataccountsforanyvariationintheassessmentsofthetwocases So letusconsiderthispairofcases Inthefirst Smithstandstogainalargeinheritanceifanythingshouldhappentohissix year oldcousin Oneeveningwhilethechildistakinghisbath Smithsneaksintothebathroomanddrownsthechild andthenarrangesthingssothatitwilllooklikeanaccident Part2 T12 Inthesecond Jonesalsostandstogainifanythingshouldhappentohissix year oldcousin LikeSmith Jonessneaksinplanningtodrownthechildinhisbath However justasheentersthebathroomJonesseesthechildslipandhithishead andfallfacedowninthewater Jonesisdelighted hestandsby readytopushthechild sheadbackunderifitisnecessary butitisnotnecessary Withonlyalittlethrashingabout thechilddrownsallbyhimself accidentally asJoneswatchesanddoesnothing NowSmithkilledthechild whereasJones merely letthechilddie Thatistheonlydifferencebetweenthem Dideithermanbehavebetter fromamoralpointofview Ifthedifferencebetweenkillingandlettingdiewereinitselfamorallyimportant Part2 T13 matter oneshouldsaythatJones sbehaviorwaslessreprehensiblethanSmith s Butdoesonereallywanttosaythat Ithinknot Inthefirstplace bothmenactedfromthesamemotive personalgain andbothhadexactlythesameendinviewwhentheyacted ItmaybeinferredfromSmith sconductthatheisabadman althoughthatjudgmentmaybewithdrawnormodifiedifcertainfurtherfactsarelearnedabouthim forexample thatheismentallyderanged ButwouldnottheverysamethingbeinferredaboutJonesfromhisconduct Andwouldnotthesamefurtherconsiderationsalsoberelevanttoanymodificationofthisjudgment Moreover supposeJonespleaded inhisowndefense Afterall Ididn tdoanythingexceptjuststandt