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Unit 10
Medical Ethics
In-Class Reading
A License to Kill
1 Advocates of assisted suicide and euthanasia find a role model in Holland, the only country that permits both practices. They say its policy is a "remarkable triumph of common sense". Yet a closer look reveals the truth about the practice of euthanasia in Holland.
2 The Royal Dutch Medical Association officially endorsed euthanasia in 1984, and issued strict guidelines on how to perform it: The patient's condition must be one of unbearable suffering that cannot be relieved, and the patient must freely request to die. When a patient does ask, the doctor should not proceed without consulting an independent physician. Then each case must be reported as an "unnatural death" to local officials. Doctors who don't follow the guidelines can be imprisoned for up to 12 years.
3 Approved by parliament, the guidelines were meant to protect and empower terminally ill patients. But evidence suggests that they empower doctors instead.
4 Though patients are supposed to decide for themselves, they are sometimes influenced by doctors. If doctors judge someone's quality of life to be low, they ask, "Why should we add to the suffering?"
5 A survey commissioned by the Dutch government estimated that only 3,600 people died in 1995 as a result of assisted suicide or euthanasia. But this only included cases where the patient requested death. The survey did not count as euthanasia or physician-assisted suicide the 900 cases in which patients' lives were ended without their request and nearly 1,900 deaths in which doctors increased pain-killing drugs with the explicit intention of hastening death.
6 A 64-year-old woman, told in 1988 that she had advanced ovarian cancer, wished to die at home. When she awoke one morning covered in what looked like red pinpricks, her husband took her to the hospital. Returning to the hospital the next day to take his wife home, he took a short walk while he waited for the doctor to attend to his wife. When the husband returned to his wife's room, she was unresponsive. Three hours later she died--from lethal drugs the doctor had injected into her body.
7 The husband believes a doctor proposed the injection and his wife was swayed. "She always thought doctors knew best," the husband said. "It wasn't euthanasia--it was murder." But there was no investigation since he did not want the doctor prosecuted.
8 Because euthanasia is politically correct, prosecutors are often unwilling to press charges. Since 1981 only 20 doctors have faced the courts. Nine were convicted. Of those, six received suspended sentences, and three were given no punishment at all.
9 Doctors who have studied euthanasia in the Netherlands note that "what was intended as a solution for exceptional cases has become a routine way of dealing with terminal cases. The Netherlands has moved from euthanasia for the terminally ill to euthanasia for the chronically ill, from euthanasia for physical illness to euthanasia for psychological distress, and from voluntary to involuntary euthanasia."
10 Already, Holland's euthanasia guidelines offer scant protection to the mentally ill and newborn babies. Researchers from the University of Utrecht found that more than 40 percent of all mentally handicapped patients who died in 1995 did so after a doctor's decision to withdraw treatment, increase pain-killing drugs or give lethal injections. In that same year, doctors were charged with killing two handicapped newborns. The courts ruled that the doctors had no option but to kill. The survey commissioned by the Dutch government reports that doctors now kill about 15 nonviable newborns a year.
11 In some cases, a patient's "right to die" has subtly become a "duty to die". Some people are pressured toward euthanasia by exhausted and impatient relatives. A story is told of a woman whose relatives gathered in Amsterdam for her planned euthanasia. One relative came from overseas. When the patient had last-minute doubts, the family said, "You can't have her come all this way for nothing." Instead of ensuring that the patient's true wishes were observed, the doctor carried out the euthanasia.
12 The key alternative to euthanasia--palliative care--is largely unavailable in Holland. Originated in England 30 years ago, this philosophy of total care for the terminally ill and their families offers spiritual comfort and the control of physical and mental pain without seeking to either hasten or postpone death. Today almost all communities in the United Kingdom and many in Europe and North America provide such care, often in facilities known as hospices.
13 Dr. Robert Twycross, a leading British authority on palliative care, recalls a cancer patient who drank excessively to escape the pain and mental distress caused by his illness and finally demanded to be put to death. After pain treatment, the patient changed his mind, saying, "It wasn't me speaking. It was the alcohol."
14 "Depression often overlaps and complicates terminal illness," Twycross says. "As the patient comes out of depression, the demand for euthanasia evaporates."
15 A 65-year-old widow learned in October 1996 that neither surgery nor chemotherapy was likely to cure her cancer of the throat and stomach. But the two options available--a hospital or a nursing home--did not appeal to her, because she feared that her wishes would not be respected in either place. "I'm not afraid of death," she said, "but I don't want someone else to decide how I should die." She seriously considered euthanasia.
16 Like most Dutch people, she knew little about options in palliative care. Then an acquaintance told her about a hospice in a nearby city.
17 Five weeks later, she was sitting in the sun lounge of the hospice. "When I came here, I could hardly walk or talk, and I hadn't eaten for a month," she recalled. "After ten days, I chat, walk and feel relaxed. I know I'm not leaving here alive, but I feel like a human being."
18 She died peacefully a few weeks later. She had been cared for by a doctor with a special sense of mission--Ben Zylicz.
19 Five years before, soon after his patient was euthanized by another doctor, Zylicz quit his hospital post to dedicate himself to an alternative. "As a doctor, I saw lives taken for reasons that had little to do with healing," he says, "Now I am able to help patients in a humane and caring way.
20 "I hope that others--both doctors and patients--will have that chance." (1051 words)
Time taken: ________ minutes
Proper Names
Amsterdam
阿姆斯特丹（荷兰首都）
Ben Zylicz
（男子名）本·塞力克斯
Holland
荷兰（欧洲国家）
Robert Twycross
（男子名）罗伯特·特瓦克劳斯
Royal Dutch Medical Association
荷兰皇家医学会
United Kingdom
英国，联合王国
University of Utrecht
乌得勒支大学
New Words
advocate
1) n. a person who speaks or writes in support of a cause, person, etc. 拥护者，提倡者
e.g. He is a lifelong advocate of disarmament (裁军).
2) v. support or urge by argument, recommend publicly 拥护,提倡
e.g. I) She advocates taking a more long-term view.
II) He advocates the return of capital punishment.
caring
adj. showing affection for other people, helpful and sympathetic when they are in trouble 关怀的
e.g. Phyllis is a caring doctor and she is highly respected by her patients.
chemotherapy
n. the treatment of disease using chemicals, often used in treating cancer 化学疗法
complicate
v.
1) make an illness worse 使......变得更糟，使......更加恶化
e.g. His breathing problem has been complicated by a chest infection.
2) make something more difficult to understand or deal with 使......变得错综复杂，使......难弄
e.g. The situation is complicated by the fact that I've got to work late on Friday.
dedicate
v. devote wholly to some purpose or person, give completely (your energy, time, etc.) 献身，致力于，把（时间、精力等）用于
e.g. I) She dedicated her life to medical research.
II) The new president said she would dedicate herself to protecting the rights of the old, the sick and the homeless.
euthanasia
n. the practice of killing someone painlessly in order to stop their suffering when they are dying or have an incurable illness 无痛苦致死术，安乐死
euthanize
v. put a person or an animal to death in order to end their suffering 使安乐死
evaporate
v.
1) gradually become weaker and eventually disappear completely 消失，逐渐消散
e.g. His anger evaporated as the misunderstanding was explained.
2) change from a liquid or solid state into vapor, pass off in vapor （使液体或固体）蒸发，挥发
e.g. The water is evaporated by the sun.
freely *
adv. willingly, without being ordered or forced to do something 自愿地
e.g. She freely admits that she's not as fast a runner as she used to be.
handicapped *
adj. physically or mentally disabled 残疾的，有智力缺陷的
e.g. It's cruel to make fun of a handicapped child.
hospice
n. a health care facility for supportive care of the terminally ill (晚期病人)护理所
humane
adj. having or showing sympathy, kindness and understanding 人道的，富有同情心的
e.g. It is the responsibility of a humane society to treat animals as well as it can.
imprison *
v. put or keep somebody in prison 监禁，关押
e.g. Several of the rioters were imprisoned for causing a disturbance.
inject
v. use a needle and syringe to put a liquid, such as a medicine, into a person's body 注射
e.g. Doctors have been able to inject antibiotics (抗生素) into the blood stream for decades.
investigation *
n. an official attempt to find out the reasons for something such as a crime, accident, or scientific problem 调查，调查研究
e.g. An investigation has been under way for several days into the disappearance of a thirteen-year-old boy.
involuntary *
adj.
1) done unwillingly, or without the decision or intention of the person involved 不是出于自愿的
e.g. They argued that legalizing voluntary euthanasia would eventually lead to involuntary euthanasia.
2) unintentional, unconscious 无意识的，不自觉的
e.g. A sharp tap on the leg beneath the knee usually causes an involuntary movement of the lower leg.
license
n.
1) a reason or excuse to do something wrong or excessive 理由，借口
e.g. I) You must not see it as a license to trap people into an arrangement.
II) “Dropping the charges (撤销指控) has given racists a license to kill,” said Jim's aunt.
3) an official document which gives you permission to do, use, or own something 许可证，执照
e.g. I) Don't forget to bring your driving license.
II) The painting was returned to Spain on a temporary import license.
nonviable
adj. not capable of living, growing, and developing, as an embryo or seed 不能生长发育的
ovarian
adj. having to do with the female organs involved in egg production 卵巢的
overlap
v. cover something partly by extending over its edge 与...... 部分重叠
e.g. The tiles on the roof overlap one another.
overseas
1) adv. in, from, or to countries that are across the sea (在、向或来自)海外，（在、向或来自）国外
e.g. I) Most applications came from overseas.
II) If you are living overseas, you may not have to pay tax in your own country.
2) adj. coming from or happening abroad 来自海外的，在海外的
e.g. I) Every year nine million overseas visitors come to London.
II) He has returned to South Africa from his long overseas trip.
palliative
adj. serving to relieve suffering without treating the cause of the suffering 减轻的，缓和的，治标的
parliament
n. a law making body (usually British or of the British Commonwealth) 国会，议会
e.g. I) On Tuesday the country's parliament voted to establish its own army.
II) In Britain, Parliament consists of the House of Commons, the House of Lords and the king or queen, although people often mean only the House of Commons when they refer to Parliament.
pinprick
n. a very small dot of something, or a very small hole in something, similar to one made by a pin 小孔，针刺的孔
prosecutor *
n. a legal representative who officially accuses someone of committing a crime, especially in a court of law 检察官，公诉人
e.g. The judge asked the prosecutor to call the first witness.
scant
adj. not enough 不足的，欠缺的
e.g. I paid scant attention to all my father's warnings.
suspended *
adj. delayed, temporarily stopped 被暂时搁置的
e.g. A cut in interest rates would lift the economy out of its current state of suspended animation (生机暂停).
sway
v.
1) change someone's opinion or judgment, influence someone 使动摇，影响
e.g. I) Don't let him sway you from your decision.
II) Recent developments have swayed the balance of power in the region.
2) (cause someone or something to) move slowly from side to side (使......)摇摆
e.g. I) The ship swayed from side to side on the rough seas.
II) A drunk was standing in the middle of the street, swaying uncertainly and trying hard to stay upright.
terminally *
adv. with regard to the last stage in a fatal disease 晚期地，致命地
e.g. That hospital is mainly for terminally ill patients.
unavailable *
adj. not able to be obtained 不可获得的
e.g. Funding for the new school is unavailable.
unresponsive *
adj. not reacting to anything or making any movements 没有反应的
e.g. I found her in a coma (不省人事), totally unresponsive.
Phrases and Expressions
add to
make something such as a feeling or quality stronger and more noticeable 增加
e.g. I) He is given answers that only add to his confusion.
II) Smiles, nods, and cheerful faces added to the general gaiety (欢乐).
appeal to
be attractive to 吸引
e.g. The idea of becoming a successful businessman appeals to him.
as a result of
because of something that has happened 由于
e.g. As a result of the pilots' strike, all flights have had to be cancelled.
attend to
care for or deal with someone or something 照料，护理，处理
e.g. I) The doctors try to attend to the worst injured soldiers first.
II) There are more pressing matters to be attended to today.
be meant to
be thought, intended, or expected to 应该是，希望是
e.g. They are meant to be good cars.
charge someone with
accuse someone of 指挥某人做某事
e.g. I) The doctor was charged with murdering his patient.
II) The press charged her with using the company's money for her own purposes.
dedicate... to
devote... to 献身于
e.g. He decided to dedicate himself to the anti-nuclear movement.
have no option but to
have no alternative but to, have no choice but to 别无他法，只能
e.g. I) Mr. Smith said he had no option but to leave the company.
II) When I left school I wanted to travel, but I had no money so I had no option but to work. |