Unit03DoctorDilemma

Doctors Dilemma: Treat or Let Die?,Abigail Trafford,Background information,About the author: Abigail (/5Abel/) Trafford is an author, columnist and former editor of the health section of the Washington Post. She hosts “Health Talk,” an online talk show on . Trafford is the author of Crazy Time: Surviving Divorce and Building a New Life (1982) and My Time: Making the Most of the Rest of Your Life (2004).,Duk Koo Kim: (1959-1982) a South Korean boxer, who died after losing a lightweight title fight in a brave display of will and courage against popular champion Ray “Boom Boom” Mancini. This fight fatally injured Duk-Koo Kim in 14th round of a boxing match on November 13, 1982. Minutes after the fight was over, Kim collapsed into a coma (昏迷), and was taken to a hospital.,Emergency brain surgery was done there to try to save his life, but that effort proved to be futile, as Kim lost his life five days after the match, on November 18. Following this fight, the number of rounds was changed from 15 to 12.,The Hospice Movement(临终关怀运动): A hospice is a place where people who have a terminal or fatal illness are treated until they die. The hospice movement specializes in pain control and the aim of the hospice movement is to give people with painful and terminal diseases the best possible quality of life. The modern hospice movement began in the 1960s and many have a Christian foundation. Although many of the doctors and nurses who work at the hospices may be Christian, the patients can be of any faith or of none.,The staff not only look after the patients, they help them prepare for their deaths and also help the relatives prepare for the loss of their loved ones. The atmosphere at a hospice will be a loving and caring one, where the patients and the relatives are encouraged to talk about death and dying. Hospices are concerned not only with the physical heath of their patients, but also with their emotional, psychological and spiritual health.,Parkinsons disease (帕金森氏病): a disease of the nervous system which causes the muscles to become stiff and the body to shake, and which gradually gets worse as a person gets older. The disease was first discovered and its symptoms documented in 1817 by the British physician Dr. James Parkinson. In the United States, the prevalence of Parkinsons disease is 1 per 625 people, though this increases with age, as indicated by the mean onset of 55 years of age.,Alzheimers disease (阿耳茨海默氏病): a serious disease, especially affecting older people, that prevents the brain from functioning normally and causes loss of memory, loss of ability to speak clearly, etc. The symptoms of the disease as a distinct nosologic entity were first identified by Emil Kraepelin, and the characteristic neuropathology was first observed by Alois Alzheimer in 1906. In this sense, the disease was co-discovered by Kraepelin and Alzheimer, who worked in Kraepelins laboratory.,Because of the overwhelming importance Kraepelin attached to finding the neuropathological basis of psychiatric disorders, Kraepelin made the generous decision that the disease would bear Alzheimers name. 2-3% of persons aged 65 show signs of the disease, while 25% or more of persons aged 85 have symptoms of Alzheimers and an even greater number have some of the pathological hallmarks (病理特征) of the disease without the characteristic symptoms.,The proportion of persons with Alzheimers begins to decrease after age 85 because of the increased mortality (死亡率) due to the disease, and relatively few people over the age of 100 have the disease.,spina bifida (脊柱裂/ /): a serious condition in which a persons spine does not develop correctly before they are born, so that their spinal cord (脊髓) is not protected. Spina bifida results in varying degrees of paralysis, absence of skin sensation, incontinence, and spine and limb problems depending on the severity and location of the lesion damage on the spine. In very rare cases, cognitive problems also result.,Most babies born with the condition will need surgeries to correct spinal, foot or leg problems, shunt surgery to drain fluid from the brain, application of techniques to control bladder and bowel function, and braces and other equipment to assist in walking. In the United States, spina bifida occurs in about one in every 1-2,000 births.,Downs syndrome (唐氏综合征): a condition which some people are born with and which means they have lower than average mental ability, a flat face and nose, and sloping eyes. Downs syndrome encompasses a number of genetic disorders, of which trisomy 21 is the most representative, causing highly variable degrees of learning difficulties and physical disabilities.,It is named for John Langdon-Down, the British doctor who first described it. Incidence of Down syndrome is estimated at 1 per 660 births, making it the most common chromosomal abnormality. Maternal age influences the risk of conceiving a baby with the syndrome. At age 20-24, it is only 1/1490, while at age 40 it is 1/106 and at age 49 it is 1/11.,Introduction to the text,Human beings have always faced basic questions of ethics. But modern technology has brought many new complications that make such decisions more difficult now. This is especially true in medicine where the ethical decisions are matters of life and death.,The wonders of modern medicine dazzle us daily as we read about new discoveries and lifesaving techniques. Smallpox (天花), one of the ancient scourges of humanity, has now been virtually eliminated. Patients whose kidneys have ceased to function live on thanks to the recently invented dialysis (/da5Alss/血液透析) machine. People who just a few decades ago would have been pronounced dead when their hearts stopped beating are rushed into surgery and given a new heart; many later return to normal life.,This all seems life wonderful news, but is there a darker side to these medical miracles? As is so often the case, new benefits bring new problems. It becomes more and more difficult for doctors, nurses, and patients to know what is right and wrong in medicine. The article gives an overview of these complex questions.,In the first part of the article (para.17), Abigail Trafford introduces us to the modern dilemma in medicine: whether survival or quality of life is the paramount goal of medicine, which gives rise to the growing new discipline of bioethics. Most often, hard choices concerning life or death have to be made either at the end for the treatment of the dying (para.813) or at the beginning for the very sick newborn (para.1418).,Doctors may feel they are under siege and often rely on committees to decide for them whether or not to continue treatment (para.1921). This dilemma has even moved onto the level of national policy and will remain as “the basic question in modern medicine” (para.2225).,Text and language points,1.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.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。,wonder drug:a very good and effective new medicine 特效药radiation therapy: the treatment of an illness or injury by heat, light, or elementary particles over a fairly long period of time 放射治疗；放疗法,double-edged sword: something that has as many bad results as good ones; something with one negative and one positive effect e.g. Being famous is often a double-edged sword.e.g. The competition rules must be regarded as a double-edged sword by businesses.e.g. Throughout our history, judicial review has been 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.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。,an array of:a group of people or things, especially one that is large or impressivee.g. There was a glittering array of film stars at the festival.e.g. There was a vast array of colors to choose from.e.g. They sat before an array of microphones and cameras.,outstrip: v .be greater in quantity than something else; exceed or surpass 超过；超越 e.g. The demand for food outstripped the supply. e.g. Even the most primitive computer can outstrip the human brain in certain types of calculation. e.g. Girls are now outstripping boys in all school subjects.,blur . v . to make the difference between two ideas, subjects etc less clear使模糊不清 e.g. His novels tend to blur the distinctions between reality and fantasy. e.g. The difference between male and female roles within the house has become blurred. e.g. The show blurs the difference between education and entertainment.,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.,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。,limbo: a state of uncertainty about a situation that you cant control and in which theres no advancement and improvement 前途未卜的状况；悬而未决的状况e.g. His life seemed stuck in limbo; he could not go forward and he could not go back. e.g. Im in limbo now until I know whether Ive got the job. e.g. Until weve got official permission to go ahead with the plans, were in limbo.,unconscious：a. unable to see, move, feel, etc. in the normal way because you are not conscious 人事不省的；昏迷的 e.g. Kevin was knocked unconscious by the impact. Billy was unconscious for two days after the accident. The unconscious man was carefully lifted onto a stretcher (担架).,cease: v. stop doing something or stop happening停止；终了e.g. He ceased to be a member of the association. The things people will do for charity never cease to amaze me. The rain ceased and the sky cleared.,4.In the wake of technologys advances in medicine, a heated debate is taking place in hospitals and nursing homes across the countryover whether survival or quality of life is the paramount goal of medicine.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。,in the wake of: (of something, especially something bad) happening afterwards and usually as a result of ite.g. Famine followed in the wake of the drought. e.g. They submitted the resignations in the wake of a scandal.,paramount: more important than anything else 最重要的；首要的e.g. During a war, the interests of the state are paramount, and those of the individual come last.e.g. Womens role as mothers is of paramount importance to society.,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?”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.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 difficult ethical questions ariseat the beginning for the very sick newborn and at the end for the dying patient.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。,ethics: moral rules or principles of behavior for deciding what is right and wrongExamples:This insight into the ethics of international trade comes from the Geneva-based World Economic Forum, a research organization. Furthermore, he admitted to having given the ethics panel untrue information when it investigated those projects.,welfare: the good health, happiness, prosperity, etc. of a person or group（个人或集体的）康乐；安康；幸福 Examples:Our only concern is the childrens welfare. I give you this advice for your own welfare. We are very concerned about the welfare of U.S.,ethical: of or relating to principles of what is right and wrong; morally good or correct 道德的；合乎职业道德标准的 Examples:The president must have the highest ethical standards. This type of advertisement may be legal, but is it ethical? The use of animals in scientific tests raises some difficult ethical questions.,7.The dilemma posed by modern medical technology has created the growing new discipline of 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.,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。,pose: exist in a way that may cause a problem, danger, difficulty, etc. 提出；引起；造成 Examples:Officials claim the chemical poses no real threat. The events pose a challenge to the churchs leadership,bioethics / baEeWks / n. the study connected with life and living things of what is morally right and what is not 生物伦理学chaplain / 5tFAplIn / n. a priest or other religious minister responsible for the religious needs of a club, the army, a hospital, etc. 牧师；教士psychiatrist / saI5kaIEtrIst / n. a doctor trained in the treatment of mental illness 精神病医师；精神病学家,Death and Dying8.Of all the patients in intensive-care units who are at risk of dying, some 20 percent present difficult ethical choiceswhether 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.,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.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.,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”。,pull back: decide not to do or become involved in something; get out of a bad situation or dangerous place, or make someone else do thisExamples:In the end, he pulled back from financing the film. Many banks are pulling back from international markets.,sustain: make something continue to exist or happen for a period of timeExamples:She found it difficult to sustain the childrens interest. He was incapable of sustaining close relationships with women. gasp n. a quick deep breath of pain, surprise, etc. 喘气；喘息,take over: gain or acquire control of; do sth instead of or obtain sth from someone elseExamples:Youve let this job take you over completely. This firm has taken over three companies this year.,statute: a law passed by a parliament, council, etc. and formally written downExamples:Protection for the consumer is laid down by statute. In New Mexico, a state statute permits one minute of silent prayer at the beginning of school.,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, with its emphasis on providing comfortnot cureto the dying patient, has gained momentum in many areas.,prolong: v. deliberately make something last longer; to extend延长；延伸 Examples:The drug can help prolong life. They prolonged the visit by a few days.I was trying to think of some way to prolong the conversation.,survey: a set of questions that you ask a large number of people in order to find out about their opinions or behaviorExamples:We conducted a public opinion survey in the area. The survey showed that 75% approved of the new law. A recent survey found that 36% of the women asked did not feel safe walking alone at night.,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.Despite progress in societys understanding of death and dying, thorny 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.,thorny: a. causing difficulty; complicated and difficult 棘手的；复杂困难的Examples:He may touch on several thorny border issues, such as immigration, sewage management, and economic development.The three still have to sort out the thorny question of who will run the center and where it will be.The ongoing success of his department validated his approach to the thorny problem of appraising individual effectiveness.,afflict: affect someone or something in an unpleasant way, and make them suffer使苦恼；折磨；困扰 Examples:A nightmare afflicted me from time to time.Unemployment afflicts 1.2 million workers in the country.Kidney stones afflict mostly men between 20 and 55.,clot: a thick almost solid mass forme