2021年医学考博阅读理解冲刺练习 (7)

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　　The Supreme Court's decisions on physician-assisted suicide carry important

　　implications for how medicine seeks to relieve dying patients of pain

　　suffering.

　　Although it ruled that there is no constitutional right to

　　physician-assisted suicide, the Court in effect supported the medical principle

　　of "double effect," a centuries-old moral principle holding that an action

　　having two effects — a good one that is intended a harmful one that is

　　foreseen — is permissible if the actor intends only the good effect.

　　Doctors have used that principle in recent years to justify using high

　　doses of morphine to control terminally ill patients' pain, even though

　　increasing dosages will eventually kill the patient.

　　Nancy Dubler, director of Montefiore Medical Center, contends that the

　　principle will shield doctors who "until now have very, very strongly insisted

　　that they could not give patients sufficient mediation to control their pain if

　　that might hasten death."

　　George Annas, chair of the health law department at Boston University,

　　maintains that, as long as a doctor prescribes a drug for a legitimate medical

　　purpose, the doctor has done nothing illegal even if the patient uses the drug

　　to hasten death. "It's like surgery," he says, "We don't call those deaths

　　homicides because the doctors didn't intend to kill their patients, although

　　they risked their death. If you're a physician, you can risk your patient's

　　suicide as long as you don't intend their suicide."

　　On another level, many in the medical community acknowledge that the

　　assisted-suicide debate has been fueled in part by the despair of patients for

　　whom modern medicine has prolonged the physical agony of dying.

　　Just three weeks before the Court's ruling on physician-assisted suicide,

　　the National Academy of Science (NAS)released a two-volume report, Approaching

　　Death: Improving Care at the End of Life. It identifies the undertreatment of

　　pain the aggressive use of "ineffectual forced medical procedures that

　　may prolong even dishonor the period of dying" as the twin problems of

　　end-of-life care.

　　The profession is taking steps to require young doctors to train in

　　hospices, to test knowledge of aggressive pain management therapies, to develop

　　a Medicare billing code for hospital-based care, to develop new standards

　　for assessing treating pain at the end of life.

　　Annas says lawyers can play a key role in insisting that these well-meaning

　　medical initiatives translate into better care. "Large numbers of physicians

　　seem unconcerned with the pain their patients are needlessly predictably

　　suffering," to the extent that it constitutes "systematic patient abuse." He

　　says medical licensing boards "must make it clear ... that painful deaths are

　　presumptively ones that are incompetently managed should result in license

　　suspension."

　　1. From the first three paragraphs, we learn that ________.

　　A. doctors used to increase drug dosages to control their patients'

　　pain.

　　B. it is still illegal for doctors to help the dying end their lives.

　　C. the Supreme Court strongly opposes physician-assisted suicide.

　　D. patients have no constitutional right to commit suicide.

　　2. Which of the following statements is true according to the text?

　　A. Doctors will be held guilty if they risk their patients' death.

　　B. Modern medicine has assisted terminally ill patients in painless

　　recovery.

　　C. The Court ruled that high-dosage pain-relieving medication can be

　　prescribed.

　　D. A doctor's medication is no longer justified by his intentions.

　　3. According to the NAS's report, one of the problems in end-of-life care

　　is ________.

　　A. prolonged medical procedures.

　　B. inadequate treatment of pain.

　　C. systematic drug abuse.

　　D. insufficient hospital-care.

　　4. Which of the following best defines the word "aggressive" (line 4,

　　paragraph 7)?

　　A. Bold.

　　B. Harmful.

　　C. Careless.

　　D. Desperate.

　　5. George Annas would probably agree that doctors should be punished if

　　they ________.

　　A. manage their patients incompetently.

　　B. give patients more medicine than needed.

　　C. reduce drug dosages for their patients.

　　D. prolong the needless suffering of the patients.

　　答案解析：

　　1. 答案：B

　　解析：本题的答题依据是第二段中的 “there is no constitutional right to physician-assisted

　　suicide”，即从法规上讲，在医生帮助下的自杀是不合法的。

　　2. 答案：C

　　解析：这是一道总括性的题，需要以文章中的多处信息为线索。这些信息较多地集中在文章的前三段：尽管在医生帮助下的自杀是不合法的，但是最高法院认为只要医生的本意是为了减轻病人的痛苦，那么他们使用大剂量的镇痛药就是允许的。

　　3. 答案：B

　　解析：本题的答题依据是第七段的第二句话中的“the undertreatment of pain”，理解了该短语的意思，这道题也就迎刃而解了。

　　4. 答案：A

　　解析：选择四个选项的考生人数比较平均。这道题考查考生根据上下文判断词义的能力。一方面考生对“aggressive”这个词的基本意思要有所了解，同时要运用上下文的信息。

　　5. 答案：D

　　解析：有29.6%的考生选择 A

　　项。本题的答题依据是文章的最后一段。在这一段中，Annas对大量的医生置病人的痛苦于不顾，无端地延长病人不必要的痛苦这种行为提出了批评，认为这种行为构成了“虐待病人”，并认为这样的医生应该予以吊销行医执照。考生选择

　　A 的主要原因是受到了最后一句话中的“that are incompetently managed”的影响。

　　参考译文：

　　最高法庭关于医生协助病人结束生命问题的裁决，对于如何用药物减轻病危者的痛苦这个问题来说，具有重要的意义。

　　尽管裁决认为，宪法没有赋予医生帮助病人自杀的权利，然而最高法庭实际上却认可了医疗界的“双效”原则，这个存在了好几个世纪的道德原则认为，如果某种行为具有双重效果(希望达到的好效果和可以预见得到的坏效果)，那么，只要行为实施只是想达到好的效果，这个行为就是可以允许的。

　　近年来，医生们一直在借用这项原则，为自己替病危患者注射大剂量的吗啡镇痛的做法提供正当的理由，尽管他们知道，不断增加的剂量最终会杀死病人。蒙特非奥里医疗中心主任南希?都博勒认为，这项原则将消除部分医生的疑虑，这些医生在此之前一直强烈地认为，如果给病人充分的药品来止痛会加速他们的死亡的话工那就不能这样做。

　　波士顿大学健康法律系主任乔治?安纳斯坚持认为，只要医生是出于合理的医疗目的开药，那么即使服用此药会加速病人的死亡，医生的行为也没有违法。“这就像做手术，”他说，“我们不能称那些死亡为杀人是因为医生并没有想杀死病人，尽管他们敢冒病人死亡的危险。假定你是一名医生，只要你并没有想让病人自杀，你就可以去冒你的病人自杀的风险。”

　　另一方面，许多医疗界人士承认，致使医助自杀这场争论升温的部分原因是由于病人们的绝望情绪，对这些病人来说，现代医学延长了临终前肉体的痛苦。

　　就在最高法庭对医助自杀进行裁决的前三周，全国科学学会公布了一份长达两卷的报告——临近死亡：完善临终护理。报告指出了医院临终关怀护理中存在的两个问题：对病痛处理不力和大胆使用“无效而强制性的医疗程序，这些程序可能会延长死亡期，甚至会让死亡期难堪”。

　　“医疗行业采取步骤，让年轻医生去晚期病人休养所培训，对各种大胆的镇痛疗法方面的知识进行评估，为医院护理制定一份符合美国医疗保障方案的付款条例，以及为评估和治疗临终痛苦制定新的标准。

　　安纳斯说，律师可以在要求把医疗界的这些善意的行为变成更好的护理行动方面发挥关键作用。“不少医生对病人所遭受的毫无必要的，可预见的痛苦无动于衷”，乃至于已构成“蓄意虐待病人”。他说，行医资格理事会“必须明确表明——病人痛苦地死亡，可以推定，是由于医生处理不力造成的，应该因此吊销其从医资格”。

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