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读与写中国人民大学出版社1/54EnglishforMasterStudentsinMedicalUniversitiesChinaRenminUniversityPress2/54教材总主编卢凤香主编：张海萍张华君殷红梅编者：闵楠苏萍任雁郑守志刘娟谢瑜3/54课件制作主编：郑守志刘娟课件制作参加人：张海萍张华君卢凤香课件审阅人：美籍教授JamesBoulton4/54Unit5TextAKillingTrustbetweenDoctorsandPatients5/54OutlineBackgroundinformationtoTextAAnalysisofthetextGlobalanalysisofthetextAnalysisofthetextstructureSummaryofthetextReferenceanswerstotheexercises6/54BackgroundinformationtoTextAIntroductiontotheauthorKevinYuillBA(EastLondon),MPhil(Cambridge),PhD(Nottingham),hejoinedtheUniversityofSunderlandin1999aslecturerinAmericanStudies.HeisaFulbrightScholar.

HeteachesAmericanStudiesandAmericanhistory.7/54BackgroundinformationtoTextAIntroductiontothetopicTrustisoneoftoday’sbiggestissues.Agoodmedicalpracticedependsonthetrustbetweenthedoctorsandthepatientsaswellastheirfamilies.8/54BackgroundinformationtoTextAIntroductiontothetopicTrustisthefundamentalcomponentofthedoctor-patientrelationship;withouttrust,patientswouldnotconfideindoctorsandseekadvice.Trustalsomatters,becauseatreatmentismorelikelytowork,ifwebelievewhatthedoctorsaysandbelieveinthemedicineprescribed.Thisisknownastheplaceboeffect–wherebyapatient’sbeliefinthebenefitofadrugortreatmentistranslatedintoimprovementsinthecondition.Trustisthereforeimportantforourwellbeing.9/54BackgroundinformationtoTextAIntroductiontothetopicHowever,currently,thetrustbetweendoctorsandpatientsisbeingbrokendown.Wecanfindmanyexamplesathand.10/54BackgroundinformationtoTextARelatedbackgroundinformationA.TheUK’sAssistedDyingfortheTerminallyIllBillIntroducedintheHouseofLordsonthe8thofJanuary,itincludes17parts.Theyare:Authorizationofassisteddeath;Qualifyingconditions;Offerofpalliativecare;Declarationmadeinadvance;11/54BackgroundinformationtoTextARelatedbackgroundinformationTheUK’sAssistedDyingfortheTerminallyIllBillFurtherdutiesoftheattendingphysician;Revocationofdeclaration;Dutiesofphysicians,andconscientiousobjection;Psychiatricreferral;Notificationofnextofkin;12/54BackgroundinformationtoTextARelatedbackgroundinformationTheUK’sAssistedDyingfortheTerminallyIllBillX. Protectionforphysiciansandothermedicalpersonnel;XI. Offences;XII. Insurance;XIII. Requirementsastodocumentationinmedicalrecords;13/54BackgroundinformationtoTextARelatedbackgroundinformationTheUK’sAssistedDyingfortheTerminallyIllBillXIV. Monitoringcommissionandreportingrequirements;XV. Administrationofdrugstopatientssufferingseveredistress;XVI. Powertomakeregulations;XVII. Shorttitleandextent.14/54BackgroundinformationtoTextARelatedbackgroundinformationB.SlipperyslopeIt’satrickyprecarioussituation,especiallyonethatleadsgraduallybutinexorablytodisaster.Indebateorrhetoric,theslipperyslopeisanargumentforthelikelihoodofoneeventortrendgivenanother.Itsuggeststhatanactionwillinitiateachainofeventsculminatinginanundesirableeventlater.Theargumentissometimesreferredtoasthethinendofthewedgeorthecamel'snose.Theslipperyslopecanbevalidorfallacious.15/54BackgroundinformationtoTextARelatedbackgroundinformationB.SlipperyslopeThecamel'snoseisametaphorfromanArabiantalewhichcautionspeopleagainstallowingasmall,insignificantproblemtodeteriorateintosomethinglarge,terribleandoutofcontrol.Ifyouseeacamelroamingroundoutsideofyourtent,sogoesthestory,you'dbetterchaseitoffrightaway.Ifyoudon't,thecamelwillpokehisnoseintoyourtent.Ifyoudonothingaboutthat,soonerorlateritwillstickhisheadintothetentaswell,thentheneckandthenthetorso.Beforeyouknowit,thewholecamelisinthetent,lockstockandbarrel,plunderingandmakingamessofthings.16/54BackgroundinformationtoTextARelatedbackgroundinformationC.Dr.JosefMengeleInfamousNazidoctorthatwasnicknamed“TheAngelofDeath.”HeandtheotherNazidoctorsatthedeathcampstorturedmen,womenandchildrenanddidmedicalexperimentsofunspeakablehorrorduringtheHolocaust.Victimswereputintopressurechambers,testedwithdrugs,castrated,frozentodeath.Childrenwereexposedtoexperimentalsurgeryperformedwithoutanesthesia,bloodtransfusionsfromonetoanother,isolation,enduranceandreactiontovariousstimuli.Thedoctorsinjectedsubjectswithlethalgerms,performedsexchangeoperationsandremovedorgansandlimbs.17/54BackgroundinformationtoTextARelatedbackgroundinformationD.GMCTheGeneralMedicalCouncil,theregulatorofthemedicalprofessionintheUnitedKingdom.TheGMClicensesdoctorstopracticemedicineintheUK.Itspurposeistoprotect,promoteandmaintainthehealthandsafetyofthepublicbyensuringproperstandardsinthepracticeofmedicine.18/54BackgroundinformationtoTextARelatedbackgroundinformationE.Oregon’sDeathwithDignityActOnOctober27,1997physician-assistedsuicidebecamealegalmedicaloptionforterminallyillOregonians.TheOregonDeathwithDignityAct,acitizens'initiative,wasfirstpassedbyOregonvotersinNovember1994byamarginof51%infavorand49%opposed.ImmediateimplementationoftheActwasdelayedbyalegalinjunction.Aftermultiplelegalproceedings,includingapetitionthatwasdeniedbytheUnitedStatesSupremeCourt,theNinthCircuitCourtofAppealsliftedtheinjunctiononOctober27,1997andphysician-assistedsuicidethenbecamealegaloptionforterminallyillpatientsinOregon.19/54BackgroundinformationtoTextARelatedbackgroundinformationE.Oregon’sDeathwithDignityActInNovember1997,Measure51(authorizedbyOregonHouseBill2954)wasplacedonthegeneralelectionballotandaskedOregonvoterstorepealtheDeathwithDignityAct.VoterschosetoretaintheActbyamarginof60%to40%.TheDeathwithDignityActallowsterminallyillOregonresidentstoobtainfromtheirphysiciansanduseprescriptionsforself-administered,lethalmedications.TheActstatesthatendingone'slifeinaccordancewiththelawdoesnotconstitutesuicide.TheDeathwithDignityActlegalizesphysician-assistedsuicide,butspecificallyprohibitseuthanasia,whereaphysicianorotherpersondirectlyadministersamedicationtoendanother'slife.20/54BackgroundinformationtoTextARelatedbackgroundinformationF.DoubleeffectTheprincipleofdoubleeffect(PDE)ordoctrineofdoubleeffect(DDE),sometimessimplycalleddoubleeffectforshort,isathesisinethics,usuallyattributedtoThomasAquinas.Theprincipleseekstoexplainunderwhatcircumstancesonemayactinawaythathasbothgoodandbadconsequences(adoubleeffect).Itmaintainsseveralconditionsthatmustbemetinorderforanactiontobeconsideredmorallyright,eventhoughaccompaniedbysomesortofevileffect:21/54BackgroundinformationtoTextARelatedbackgroundinformationF.Doubleeffecttheactitselfmustbegoodormorallyneutral;thegoodeffectmustbearesultoftheactandnotoftheevileffect;theevileffectmustnotbedirectlywilled,butmaybeforeseenandtolerated;thegoodeffectoutweighstheevileffect,orthetwoareatleastcomparable.22/54BackgroundinformationtoTextARelatedbackgroundinformationG.Habermas(1929—)JürgenHabermas,aGermanphilosopherandsociologistinthetraditionofcriticaltheoryandAmericanpragmatism,bestknownforhisconceptofthepublicspherebasedonhistheoryandpragmaticsofcommunicativeaction.23/54BackgroundinformationtoTextARelatedbackgroundinformationG.Habermas(1929—)Hisworkfocusesonthefoundationsofsocialtheoryandepistemology;theanalysisofadvancedcapitalistindustrialsocietyandofdemocracy;theruleoflawinacriticalsocial-evolutionarycontext;andcontemporary–especiallyGerman–politics.24/54BackgroundinformationtoTextARelatedbackgroundinformationG.Habermas(1929—)Hedevelopedatheoreticalsystemdevotedtorevealingthepossibilityofreason,emancipationandrational-criticalcommunicationembeddedinmodernliberalinstitutionsandinthehumancapabilitiestocommunicate,deliberateandpursuerationalinterests.25/54BackgroundinformationtoTextARelatedbackgroundinformationH.Pandora’sBoxAccordingtoEdithHamiltoninMythology,thesourceofallmisfortunewasPandora’scuriosity.“Thegodspresentedherwithaboxintowhicheachhadputsomethingharmful,andforbadeherevertoopenit.ThentheysenthertoEpimetheus（艾皮米修斯潘,潘多拉丈夫）,whotookhergladlyalthoughPrometheushadwarnedhimnevertoacceptanythingfromZeus.Hetookher,andafterwardwhenthatdangerousthing,awoman,washis,heunderstoodhowgoodhisbrother’sadvicehadbeen.

26/54BackgroundinformationtoTextARelatedbackgroundinformationH.Pandora’sBoxForPandora,likeallwomen,waspossessedofalivelycuriosity.Shehadtoknowwhatwasinthebox.Onedaysheliftedthelidandoutflewplaguesinnumerable,sorrowandmischiefformankind.InterrorPandoraclappedtheliddown,buttoolate.Onegoodthing,however,wasthere—Hope.Itwastheonlygoodthecaskethadheldamongthemanyevils,anditremainstothisdaymankind’ssolecomfortinmisfortune.”27/54BackgroundinformationtoTextARelatedbackgroundinformationH.Pandora’sBoxToopenaPandora'sBoxistocreateanuncontrollablesituationthatwillcausegreatgrief.28/54Analysisofthetext

1)Duringmylastdays,ifIamsparedasuddendeath,Iwanttobeableto…(Paragraph1)spare:torefrainfromhurting,damagingordestroying;toshowmercytosparesb’slife,sparesbhislifeExample:Wemaymeetagainifwearespared.29/54Analysisofthetext

2)Insidethebreastofalldoctors,bothsidesoftheargumentagree,beatstheheartofaMengeleagainstwhompatientsmustbeprotected.(Paragraph2)MengeleisthevillainfromthemovieForgivingDr.Mengele.ThemovietellsthestoryofashockingactofforgivenessbyAuschwitzsurvivorEvaMozesKorandthefirestormofcriticismithasprovoked.Evaandhertwinsister,Miriam,werevictimsofNazidoctorJosefMengele'scruelgeneticexperiments—anexperiencethatwouldhaunttheirentirelives.Here,thewordisusedfiguratively,meaningthedeepevilnessinsidehumanheart.30/54Analysisofthetext

3)LastweekIrwinwasstruckoffthemedicalregisterbytheBritishGeneralMedicalCouncil(GMC),fortryingtohelpaterminally-illfriendtoendhislifein…(Paragraph3)strikeoff:removeExample:Thestudent’snamewasstruckofftheenrollment.terminal:oforformingthepointorplaceattheendExample:terminalcancer(癌症晚期)；terminalward(弥留病房)31/54Analysisofthetext

4)Aredoctorscurrentlyembarkingonmurderousmissions,waitinguntilpatientsareunabletoobject?(Paragraph5)

Aredoctorswaitingtokillpatientsuntiltheybecomeabsolutelyunabletoshowanysignsofobjection?embarkon:beginacourseofaction,especiallyonewhichisimportantordemandingExample:Soonafterhereturnedfromhisarmyservice,heembarkedonanewcareer.32/54Analysisofthetext

5)…inwhichimaginationbecomesahandysubstituteforlackoffacts.(Paragraph5)handy:(ofthings,places)convenient;usefulExample:Agoodtoolboxisahandythingtohaveinthehouse.33/54Analysisofthetext

6)…thatdoctorsaresnuffingoutpatientsatanygreaterratethanpreviously.(Paragraph5)snuffout:putout,extinguish;(fig)tokill34/54Analysisofthetext

7)Noristheremuchsupportfortheworstfearsofopponentsofassistedsuicide.(Paragraph6)Theopponentsofassistedsuicidegotoofar,andeventheirworstfearsareprovedtobeunfounded.35/54Analysisofthetext

8)UnderOregon’sDeathwithDignityAct,……,physician-assistedsuicidehasaccountedforbetween0.06and0.14percentoftotaldeaths,…….(Paragraph7)accountfor:toberesponsibleforExample:Thelargeamountofrainfallaccountsfortheflood.36/54Analysisofthetext

9)TheestimatefordeathsinBritain,shouldtheproposedlegislationbecomelaw,is650.(Paragraph7)

Ifassistedsuicidebecomeslawful,itisestimatedthat650peoplewilldie.‘shouldtheproposedlegislationbecomelaw’isusedininvertedordertoconveythesubjunctivemood.Thesentencecouldbeunderstoodinthisway:Iftheproposedlegislationbecomeslaw,theestimatefordeathsinBritainis650.37/54Analysisofthetext

10)Inotherwords,veryfewpeoplewillavailthemselvesofthisoptioneveniftheyaregivenit.(Paragraph7)Thatistosay,fewpatientsabletomakethechoiceofeuthanasiawillactuallydoso.toavailoneselfof:tomakeuseof,toprofitby,totakeadvantageofExample:YoushouldavailyourselfofeveryopportunitytopracticeoralEnglish.38/54Analysisofthetext

11)NodoctorinBritainhassofarbeensuccessfullyprosecuted,muchlessjailedforperformingthislastactofkindness.(Paragraph8)NodoctorinBritainhasbeeneventakentocourtforassistingapatientinsuicide,nottomentionjailed.muchless:(usedtoindicatethatwhathasbeenstatedaboutsomethingapplieswithgreaterforcetothefollowingstatement)Example:Ididn’tevenspeaktohim;muchlessdiscussyourproblemswithhim.39/54Analysisofthetext

12)Mostpeople,theevidenceshows,willwantreleaseonlyfromthelasthoursoflife.(Paragraph9)Evidenceshowsthatusually,onlywhenapersonrealizesthattheywilldieinafewhours,willtheywanteuthanasia.40/54Analysisofthetext

13)Clause3oftheBillplacesontheattendingphysiciananobligationtoensurethat“aspecialistinpalliativecarewhoshallbeaphysicianhasattendedthepatienttodiscusstheoptionofpalliativecare.(Paragraph9)Clause3oftheBillimposesadutyontheattendingphysiciantoensurethataspecialistinthetreatmentofincurablediseaseshasmetwithanddiscussedwiththepatientalloptionsavailable.41/54Analysisofthetext

14)…provideforthedocumentationnecessaryforanaudittrail…(Paragraph11)…provideforthedocumentationnecessaryforastep-by-steprecordbywhichdatacanbetracedtoitssource…audittrail:Astep-by-steprecordbywhichfinancialdatacanbetracedtoitssource.42/54Analysisofthetext

15)…onceaprocessgovernedinformallyisregulatedbythestate,itthrowsintoquestionallotherinformalprocessesconnectedwiththeoriginalprocess.(Paragraph12)…Whenaprocessthatwasnotpreviouslyformallygovernedbyacountrybecomesformallygoverned,newquestionsarearousedconcerningalloftheotherinformalprocessesrelatedtoit.43/54Analysisofthetext

16)Theconceptofthepatientasfirstandforemostanindividualwillbereplacedbyageneric“patient”whoseevenmoregeneric“qualityoflife”isdeterminednotbyindividualqualitiesandrelationshipsbutbyaflowchart.(Paragraph13)Thegenericconcept“patient”willreplacethemoreimportantconceptof“individual.”Lifewillend,notbasedontheindividual’squalityoflifeorrelationships,butondocumentsandpapers.Generic:relatingtoordescriptiveofanentiregrouporclass;general(synonym)44/54Analysisofthetext

17)EvenassistedsuicidecampaignerslikeTimothyLearyoftenbackoutoftheactanddienaturaldeaths.(Paragraph14)backoutof:withdraw(fromapromiseorundertaking)Example:Hepromisedtohelpandthenbackedoutofit.45/54Analysisofthetext

18)Forthesakeofperhaps650depressedanddeterminedsoulsperyear,thehopeforapeacefuldeathformillionsofothersareimperiledasagenuinegestureofhumandecencyis“madeovert.”(Paragraph14)Bymakingagenuinedesirefordecencyintolawonlyabout650patientswhowanteuthanasiawillbenefit.Unfortunately,thehopeforapeacefuldeathsharedbymillionsofpeoplewillbeendangered.46/54GlobalanalysisofthetextThistextbeginswiththeAssistedDyingBill.Thebillarousedtheauthor’sargumentsconcerningwhetherornotthebillshouldbepassed.Ontheonehand,sinceitiswell-recognizedthatdoctorsarealwayscrueltopatients,thetrustbetweendoctorsandtheirpatientsisseriouslyendangered.Thusitisnecessarytopassalawtoregulatethebehaviorofdoctors.Ontheotherhand,legislatingthebenevolentbehaviorofdoctors--toassistinapatient’sdeath--willstrictlylimitdoctors.Toacertainextent,itisneedlesstolegislatethebehaviorofdoctorswhoassistinapatient’sdeath.Ifsuchalawweretobepassed,itwouldspoilthetrustbetweenthedoctorandpatientandnotmanypeople,onlyafew,wouldbenefitfromtheimplementationofthebill.

47/54

Analysisofthetextstructure

Thetextfallsintofourparts.PartIParagraph1putsforwardthetopic---theAssistedDyingBill.PartIIParagraphs2-4illustratethenegativeimpactsofthebillonthedoctor-patientrelationshipwithexamples.48/54

Analysisofthetextstructure

Thetextfallsintofourparts.PartIIIParagraphs5-12illustratethefutilityandneedlessnessoflegislatingassisteddying.PartIVParagraphs13-14statethatmostpeoplewouldchooseeuthanasiaonlyduringthelastfewhoursoftheirlife.49/54Summaryofthetext

Peoplearebornwithcertainrights.However,somerightsarenotalwayscompatible.Howtosolvesuchkindsofproblemsbecomesatoughjobfacedwith,forexampleinthetext,thedoctorsandpatients.TheauthorliststheadvantagesandweaknessesofTheRightsTheory,andthendiscussestherightsofeverypartyinvolvedinthecase.Atlast,heconcludesthattheRi