Unite 3 Doctor’s Dilemma: Treat or Let Die?
Abigail Trafford
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.
2. Doctor’s power to treat with an array of space-age techniques has outstripped the body’s 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.
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.
4. In the wake of technology’s 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.
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?‖
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 difficulty
ethical questions arise --- at the beginning for the very sick newborn and at the end for the dying patient.
7. The dilemma posed by modern medical technology has created the growing new discipline or bioethics. Many of the country’s 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. Death and Dying
8. 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.
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 patient’s ―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.
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, which its emphasis on providing comfort --- not cure --- to the dying patient, has gained momentum in many areas.
11. Despite progress in society’s understanding of death and dying, theory issues remain. Example: A woman, 87, afflicted by the nervous-system disorder of Parkinson’s 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 woman’s 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. 12. 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. 13. 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 Alzheimer’s disease. After the killing, the victim’s widow said: ―I think God, Jim’s out of his misery. I hate to think it had to be done the way it was done, but I understand it. ‖ Crisis in Newborn Care
14. 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. Newborn care has got huge progress, so it is absolutely clear that human being can survive independently 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.
15. 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.
16. “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.‖
17. 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 from Down’s 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.
18. ―Every time Melanie has a bowel movement, she cries,‖ explains her mother.
―She’s not able to take care of herself, and we won’t live forever. I wanted to save her from sorrow, pain, and suffering. I don’t understand the emphasis on life at all costs, and I’m very angry at the doctors and the hospital. Who will take care of Melanie after we’re gone? Where will you doctors be then?‖ Changing Standards
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.
20. 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.
21. 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. Public Policy
22. In recent years, the debate on medical ethics has moved to the level of national policy. ―It’s just beginning to hit us that we don’t have unlimited resources,‖ says Washington Hospital Center’s Dr. Lynch. ―You can’t talk about ethics without talking
研究生公共英语教材阅读B第3、4、10、11、14课文原文及翻译
