Section (B)
Decisions of the Heart
Assume for a moment that your 90-year-old mother has recently suffered a stroke. She is right-handed, and now she is unable to move her right arm and leg — they are worthless to her. She canmake sounds, but she can't make herself understood.
The condition has lasted two months and since there has been no sign of improvement, the doctortells you she will never get significantly better. Until this time your mother has always been an active,independent person who lived on her own. Now she is completely dependent on others.
Next, x-rays show your mother has a lung infection — a frequent problem with stroke patients. Thedoctor then calls you, her only surviving relative.
"We can treat the infection with drugs and she'll probably get better in a week," he says. "When I saybetter, I mean she'll go on as she has — until some other germ comes along. Or I can deny her themedicine, in which case she'll probably die in three or four days. We can make those days comfortableby giving her painkillers and sleeping pills. Which course do you want me to follow?"Tough question, isn't it? On the one hand, you cannot bear to see your once vigorous mother livingthe painful, limited life to which the stroke has condemned her. On the other hand, you hate to be theone to decide to let nature take its course.
I'll tell you which choice I would make in this theoretical situation. I'd say, "Don't give her anything tofight the infection. Keep her comfortable and let's see what happens; maybe she'll fight off the infectionon her own and if she doesn't, she'll die a peaceful death. I don't want to be responsible for condemningmy mother to a living hell."I can make this decision because I've gone down this road with patients many times. Recently Ioperated in vain on an eighty -year-old woman with cancer of the liver ... There was nothing I could doto relieve the problems the cancer had caused. She was an intelligent woman, without any closerelatives, and a couple of days after the operation I sat down with her and explained the situation.
"I can give you some anti-cancer drugs," I said, "but they will make you sick and cannot cure you.
Similarly, I can give you fluids through a needle in your arm, which will keep you fed as your appetiteslips away; the fluids might add a week or two to your life. Or I can withdraw all other treatment andjust give you a vitamin pill, and we can see what happens. Personally, my recommendation would bethe last choice. I'll keep you comfortable, and we'll see what happens."The patient elected to follow my advice and died peacefully, pain free, a fortnight later.
Sometimes such a transparent decision is more difficult to come by. Recently I had a patient whosuffered a severe stroke. He was completely unable to move and couldn't swallow anything. We gavehim fluids for the first two weeks and then fed him through a tube which passed through his nose intohis stomach.
After three weeks he was still completely unconscious, and the tube caused him to have a constant,painful sore throat ... I talked to his four grown children and told them I thought we should insert atube directly into his stomach through a small hole so he could be fed without so much pain. I also toldthem, "I can remove the tube and just let him swallow whatever he can. Chances are he won't live long,but he won't be in pain." No one wanted to take the responsibility for permitting an operation, yet noone would give permission to stop feeding the patient entirely.
As a result, the poor man continued on for nearly three more months with a painful throat andfrequent bleeding caused by sores in the mouth. He died of a major infection - a sad way to die.
So what should responsible persons do when confronted with the necessity of such an enormousdecision?
What it all comes down to is common sense. For the 30 years I have been a doctor, and for hundredsof years before that, doctors and families have been quietly cooperating to decide what is best for apatient in the final phase of an illness.
In 95 percent of the cases a sympathetic, reasonable decision can be made after appropriatediscussion. In 5 percent of cases where such a judgment cannot immediately be reached, the properdecision will become apparent after a few days or weeks of basic treatment, observing the patient'sprogress.
Let me sound one note of warning. Neither families nor doctors like to make life-death decisions. Butthere is no question that if either party insists on bringing in a so-called "neutral"; third party (usuallysome representative of the state or legal profession), not only will the process take longer, in manyinstances it will be more arbitrary and less sympathetic.
What we are trying to avoid is neutrality; the only people with any qualification to decide are thosewho know the patient intimately and can put his or her interests first. If there's one place from whichthe interference of lawyers and government officials should be barred, it's from the rooms of critically illpatients.
Words: 902
New Words
stroke n. 1.中风 2.击，打，敲
vt. 抚摸
worthless a. 无价值的，没有用处的
dependent a. 1.依赖的，依靠的 2.取决于... ...的
x-ray n. 1. [C] X光照片 2. [C] X射线; X光
■infection n. 1.传染病 2.传染，感染
germ n. 1.微生物，病菌，细菌 2.萌芽，起源
deny vt. 1.拒绝给予，拒绝……的要求 2.不承认，否认
condemn vt. 1.迫使……陷于不幸的境地 2.批评，谴责 3.判……刑，给……定罪
theoretical a. 1.理论（上）的，假设的，推理的 2.根据理论（而非实践）的
hell n. 1.地狱 2.极不愉快的经历（或事） 3.用以表示愤怒或惊讶，或用以加强语气
vain a. 1.不成功的，无效的，没有意义的 2.自负的，虚荣的
eighty num. 八十
liver n. [C, U] 肝
relieve vt. 1.减轻，解除（痛苦、疾病等） 2.救济，援助
similarly ad. 也; 同样地， 类似地
withdraw vt. 收回，撤消，撤退
vi. 缩回，退出，撤退
recommendation n. 1.建议，忠告 2.推荐，介绍
elect vt. 1.选择，决定 2.选举
fortnight n. 十四天，两星期
transparent a. 1.明显的，无疑的 2.透明的
tube n. 1.管，软管 2.（伦敦的）地下铁道
throat n. 咽喉，喉咙，嗓子
insert vt. 插入，嵌进
permission n. 许可，准许，同意
necessity n. 1.必要性，需要 2.必需品
cooperate vi. 合作，协作，配合
phase n. 阶段，时期
vt. 分期计划，按阶段执行
sympathetic a. 1.有同情心的，表示同情的，同感的 2.表示好感或赞同的
so-called a. 所谓的，号称的
neutral a. 1.中立的 2.（化学）中性的
profession n. 1.（尤指需要特殊训练或专门知识的）职业 2.行业，（某一）职业界 3.声明，表白
arbitrary a. 任意的，武断的；专断的
qualification n. 1.能力，条件；合格性 2.资格，资历
intimate a. 1.亲近的，亲密的 2.私人的，秘密的
vt. 暗示，提示
intimately ad. 亲密地，私下地
interference n. 干涉，干预
bar vt. 1.阻止，不许 2.阻碍，阻塞
n. 酒吧，吧台
Phrases and Expressions
make oneself understood 使他人明白自己的意思，说清楚自己的意思
on one's own 单独，独自 独立地
be dependent on 依赖，依靠
treat with 以... ...治疗，用... ...治病
go on （情况、形势、状态等）持续不变
come along 到达，出现
on the one hand …on the other hand… 一方面... ...另一方面... ...
condemn sb. to sth. 使某人做不愿做的事，把某人逼入某种状态
take its course 任其自然发展，按常规进行
fight off 抵抗，击退，避开
be responsible for 对……负有责任
in vain 无结果地，无用地
come by 努力获得
chances are (that…) 可能
confront with 使面对（问题、挑战等）
die of 死于
come down to 归结为，实质上是
bar… from 禁止某人做某事 |