复旦研究生综合英语2(修订版)_Unit4.ppt

U8,AdditionallnformationfortheTeachersReference,TextActiveandPassiveEuthanasia,Warm-upActivities,FurtherReading,WritingSkills,AdditionalWork,Warm-upActivities,1.Trytogiveadefinitionofeuthanasia.2.Brainstormabouttheprosandconsofeuthanasia.3.Collectreferencestothisissueandtakedownnotes.4.Orderinformationandworkoutyourownopinion.,Warm-up1.1,JamesRachelswasanAmericanprofessorofmoralphilosophyandmedicalethicswhowasparticularlyconcernedwithethicalissues.BorninColumbus,Georgia,heearneddegreesatMercerUniversityandtheUniversityofCaliforniabeforejoiningtheUniversityofAlabama,BirminghamDepartmentofPhilosophyfacultyin1977.ThepopularityofhisgroundbreakingtextbookanthologyMoralProblems(1971),whichsold100,000copies,influencedAmericanuniversitiestomoveawayfrommoretraditionalphilosophicallyorientedundergraduatemoralphilosophycoursestowardmorepracticalundergraduatecoursesinethics.,AIFTTR1.1,AdditionallnformationfortheTeachersReference,1.JamesRachels(1941-2003),AIFTTR2.1,2.Euthanasia,Euthanasiaisapracticeofmercifullyendingapersonslifeinordertoreleasethepersonfromanincurabledisease,intolerablesuffering,orundignifieddeath.ThewordeuthanasiaderivesfromtheGreekfor“gooddeath”andoriginallyreferredtointentionalmercykilling.Proponentsofeuthanasiabelievethatunnecessarilyprolonginglifeinterminallyillpatientscausessufferingtothepatientsandtheirfamilymembers.Manysocietiesnowpermitpassiveeuthanasia,whichallowsphysicianstowithholdorwithdrawlife-sustainingtreatmentwhendirectedtodosobythepatientoranauthorizedrepresentative.,AIFTTR2.2,Euthanasiadiffersfromassistedsuicide,inwhichapatientvoluntarilybringsabouthisorherowndeathwiththeassistanceofanotherperson,typicallyaphysician.Inthiscase,theactisasuicide(intentionalself-inflicteddeath),becausethepatientactuallycauseshisorherowndeath.A.RelatedLawsAslawshaveevolvedfromtheirtraditionalreligiousunderpinnings,certainformsofeuthanasiahavebeenlegallyaccepted.Ingeneral,lawsattempttodrawalinebetweenpassiveeuthanasia(generallyassociatedwithallowingapersontodie)andactiveeuthanasia(generallyassociatedwithkillingaperson).Whilelawscommonlypermitpassiveeuthanasia,activeeuthanasiaistypicallyprohibited.,AIFTTR2.3,LawsintheUnitedStatesandCanadamaintainthedistinctionbetweenpassiveandactiveeuthanasia.Whileactiveeuthanasiaisprohibited,courtsinbothcountrieshaveruledthatphysiciansshouldnotbelegallypunishediftheywithholdorwithdrawalife-sustainingtreatmentattherequestofapatientorthepatientsauthorizedrepresentative.Thesedecisionsarebasedonincreasingacceptanceofthedoctrinethatpatientspossessarighttorefusetreatment.Untilthelate1970s,whetherornotpatientspossessedalegalrightofrefusalwashighlydisputed.Onefactorthatmayhavecontributedtogrowingacceptanceofthisrightistheabilitytokeepindividualsaliveforlongperiodsoftimeevenwhentheyarepermanentlyunconsciousorseverelybrain-damaged.Proponentsjets,AIFTTR2.4,oflegalizedeuthanasiabelievethatprolonginglifethroughtheuseofmoderntechnologicaladvances,suchasrespiratorsandkidneymachines,maycauseunwarrantedsufferingtothepatientandthefamily.Astechnologyhasadvanced,thelegalrightsofthepatienttoforgosuchtechnologicalinterventionhaveexpanded.EveryU.S.statehasadoptedlawsthatauthorizelegallycompetentindividualstomakeadvanceddirectives,oftenreferredtoaslivingwills.Suchdocumentsallowindividualstocontrolsomefeaturesofthetimeandmanneroftheirdeaths.Inparticular,thesedirectivesempowerandinstructdoctorstowithholdlife-supportsystemsiftheindividualsbecometerminallyill.Furthermore,thefederalPatientSelf-DeterminationAct,whichbecameeffectivein1991,requiresfederallycertifiedhealth-carebet,AIFTTR2.5,facilitiestonotifycompetentadultpatientsoftheirrighttoacceptorrefusemedicaltreatment.Thefacilitiesmustalsoinformsuchpatientsoftheirrightsundertheapplicablestatelawtoformulateanadvanceddirective.PatientsinCanadahavesimilarrightstorefuselife-sustainingtreatmentsandformulateadvanceddirectives.Asofmid-1999,onlyoneU.S.state,Oregon,hadenactedalawallowingphysicianstoactivelyassistpatientswhowishtoendtheirlives.However,Oregonslawconcernsassistedsuicideratherthanactiveeuthanasia.Itauthorizesphysicianstoprescribelethalamountsofmedicationthatpatientsthenadministerthemselves.Inresponsetomodernmedicaltechnology,physiciansandlawmakersareslowlydevelopingnewprofessionalandlegaldefinitionsofdeath.Additionally,expertsareformulatingrulestobat,AIFTTR2.6,implementthesedefinitionsinclinicalsituations,forexample,whenprocuringorgansfortransplantation.Themajorityofstateshaveacceptedadefinitionofbraindeaththepointwhencertainpartsofthebrainceasetofunctionasthetimewhenitislegaltoturnoffapatientslife-supportsystem,withpermissionfromthefamily.In1995theNorthernTerritoryofAustraliabecamethefirstjurisdictiontoexplicitlylegalizevoluntaryactiveeuthanasia.However,thefederalparliamentofAustraliaoverturnedthelawin1997.In2001TheNetherlandsbecamethefirstcountrytolegalizeactiveeuthanasiaandassistedsuicide,formalizingmedicalpracticesthatthegovernmenthadtoleratedforyears.UndertheDutchlaw,euthanasiaisjustified(notlegallypunishable)ifthemust,AIFTTR2.7,physicianfollowsstrictguidelines.Justifiedeuthanasiaoccursif(1)thepatientmakesavoluntary,informed,andstablerequest;(2)thepatientissufferingunbearablywithnoprospectofimprovement;(3)thephysicianconsultswithanotherphysician,whointurnconcurswiththedecisiontohelpthepatientdie;and(4)thephysicianperformingtheeuthanasiaprocedurecarefullyreviewsthepatientscondition.Officialsestimatethatabout2percentofalldeathsinTheNetherlandseachyearoccurasaresultofeuthanasia.B.PrevalenceAlthoughestablishingtheactualprevalenceofactiveeuthanasiaisdifficult,studiessuggestthatthepracticeisnotcommonintheUnitedStates.Inastudypublishedin1998intheNewEnglandJournalofMedicine,onlyabout6percentofbasketball,physicianssurveyedreportedthattheyhadhelpedapatienthastenhisorherowndeathbyadministeringalethalinjectionorprescribingafataldoseofmedication.(Eighteenpercentoftherespondingphysiciansindicatedthattheyhadreceivedrequestsforsuchassistance.)However,one-fifthofthephysicianssurveyedindicatedthattheywouldbewillingtoassistpatientsifitwerelegaltodoso.NocomparabledataareavailableforCanada.However,in1998theCanadianMedicalAssociation(CMA)proposedthatastudyofeuthanasiaandphysician-assistedsuicidebeundertakenduetopoorinformationonthesubject.C.EthicalConcernsTheissueofeuthanasiaraisesethicalquestionsforphysiciansandotherhealth-careproviders.Theethicalcodeofphysiciansinthe,AIFTTR2.8,AIFTTR2.9,UnitedStateshaslongbeenbasedinpartontheHippocraticOath,whichrequiresphysicianstodonoharm.However,medicalethicsarerefinedovertimeasdefinitionsofharmchange.Priortothe1970s,therightofpatientstorefuselife-sustainingtreatment(passiveeuthanasia)wascontroversial.Asaresultofvariouscourtcases,thisrightisnearlyuniversallyacknowledgedtoday,evenamongconservativebioethicists(seeMedicalEthics).Thecontroversyoveractiveeuthanasiaremainsintense,inpartbecauseofoppositionfromreligiousgroupsandmanymembersofthelegalandmedicalprofessions.Opponentsofvoluntaryactiveeuthanasiaemphasizethathealth-careprovidershaveprofessionalobligationsthatprohibitkilling.Theseopponentsmaintainthatactiveeuthanasiaisinconsistentwiththerolesofnursing,basketball,AIFTTR2.10,caregiving,andhealing.Opponentsalsoarguethatpermittingphysicianstoengageinactiveeuthanasiacreatesintolerablerisksofabuseandmisuseofthepoweroverlifeanddeath.Theyacknowledgethatparticularinstancesofactiveeuthanasiamaysometimesbemorallyjustified.However,opponentsarguethatsanctioningthepracticeofkillingwould,onbalance,causemoreharmthanbenefit.Supportersofvoluntaryactiveeuthanasiamaintainthat,incertaincases,relieffromsuffering(ratherthanpreservinglife)shouldbetheprimaryobjectiveofhealth-careproviders.Theyarguethatsocietyisobligatedtoacknowledgetherightsofpatientsandtorespectthedecisionsofthosewhoelecteuthanasia.Supportersofactiveeuthanasiacontendthatsincesocietyhasmutual,AIFTTR2.11,acknowledgedapatientsrighttopassiveeuthanasia(forexample,bylegallyrecognizingrefusaloflife-sustainingtreatment),activeeuthanasiashouldsimilarlybepermitted.Whenarguingonbehalfoflegalizingactiveeuthanasia,proponentsemphasizecircumstancesinwhichaconditionhasbecomeoverwhelminglyburdensomeforapatient,painmanagementforthepatientisinadequate,andonlyaphysicianseemscapableofbringingrelief.Theyalsopointoutthatalmostanyindividualfreedominvolvessomeriskofabuseandarguethatsuchriskscanbekepttoaminimumbyusingproperlegalsafeguards.,AIFTTR3.1,3.AmericanMedicalAssociation,TheAmericanMedicalAssociation(AMA),foundedin1847andincorporated1897,isthelargestassociationofphysiciansandmedicalstudentsintheUnitedStates.Itisanonprofitprofessionalassociationofphysicians,includingallmedicalspecialties.TheAMAspurposeistopromotetheartandscienceofmedicineforthebettermentofthepublichealth,toadvancetheinterestsofphysiciansandtheirpatients,topromotepublichealth,tolobbyforlegislationfavorabletophysiciansandpatients,toraisemoneyformedicaleducationandtoserveasanadvocatefortheadvancementoftheprofession.TheAssociationalsopublishestheJournaloftheAmericanMedicalAssociation(JAMA),whichhasthelargestcirculationofanyweeklymedicaljournalintheworld.TheAMAalsopublishesalistofPhysicianSpecialtyCodeswhichareastandardmethodintheU.S.foridentifyingphysicianandpracticespecialties.,Text,ActiveandPassiveEuthanasia,Notes,IntroductiontotheAuthorandtheArticle,PhrasesandExpressions,Exercises,MainIdeaoftheText,MainIdeaoftheText1,MainIdeaoftheText,Rachelsessay“ActiveandPassiveEuthanasia”firstappearedintheNewEnglandJournalofMedicinein1975.Init,Rachelsarguesthatkillingisnotmorallyworsethanlettingapersondieofnaturalcauses,whendoneforhumanitarianreasons.Therefore,activeeuthanasiaisnotanyworsethanpassiveeuthanasia,andincaseswhereapatientissparedneedlesspain,arguablybetter.,JamesRachels(19412003)wasanAmericanprofessorofmoralphilosophyandmedicalethicswhowasparticularlyconcernedwithethicalissues.BorninColumbus,Georgia,heearneddegreesatMercerUniversityandtheUniversityofCaliforniabeforejoiningtheUniversityofAlabama,BirminghamDepartmentofPhilosophyfacultyin1977.ThepopularityofhisgroundbreakingtextbookanthologyMoralProblems(1971),whichsold100,000copies,influencedAmericanuniversitiestomoveawayfrommoretraditionalphilosophicallyorientedundergraduatemoralphilosophycoursestowardmorepracticalundergraduatecoursesinethics.,IntroductiontotheAuthorandthearticle,IntroductiontotheAuthorandtheArticle,Rachelsessay“ActiveandPassiveEuthanasia”firstappearedintheNewEnglandJournalofMedicinein1975.Init,Rachelsarguesthatkillingisnotmorallyworsethanlettingapersondieofnaturalcauses,whendoneforhumanitarianreasons.Therefore,activeeuthanasiaisnotanyworsethanpassiveeuthanasia,andincaseswhereapatientissparedneedlesspain,arguablybetter.,IntroductiontotheAuthorandthearticle,Part2_T1,Thedistinctionbetweenactiveandpassiveeuthanasiaisthoughttobecrucialformedicalethics.Theideaisthatitispermissible,atleastinsomecases,towithholdtreatmentandallowapatienttodie,butitisneverpermissibletotakeanydirectactiondesignedtokillthepatient.Thisdoctrineseemstobeacceptedbymostdoctors,anditisendorsedinastatementadoptedbytheAmericanMedicalAssociationonDecember4,1973:,JamesRachels,ActiveandPassiveEuthanasia,Text,TheintentionalterminationofthelifeofonehumanbeingbyanothermercykillingiscontrarytothatforwhichthemedicalprofessionstandsandiscontrarytothepolicyoftheAmericanMedicalAssociation.Thecessationoftheemploymentofextraordinarymeanstoprolongthelifeofthebodywhenthereisirrefutableevidencethatbiologicaldeathisimminentisthedecisionofthepatientand/orhisimmediatefamily.Theadviceandjudgmentofthephysicianshouldbefreelyavailabletothepatientand/orhisimmediatefamily.,Part2_T2,However,astrongcasecanbemadeagainstthisdoctrine.InwhatfollowsIwillsetoutsomeoftherelevantarguments,andurgedoctorstoreconsidertheirviewsonthismatter.Tobeginwithafamiliartypeofsituation,apatientwhoisdyingofincurablecancerofthethroatisinterriblepain,whichcannolongerbesatisfactorilyalleviated.Heiscertaintodiewithinafewdays,evenifpresenttreatmentiscontinued,buthedoesnotwanttogoonlivingforthosedayssincethepainisunbearable.Soheasksthedoctorforanendtoit,andhisfamilyjoinsintherequest.,Part2_T3,Supposethedoctoragreestowithholdtreatment,astheconventionaldoctrinesayshemay.Thejustificationforhisdoingsoisthatthepatientisinterribleagony,andsinceheisgoingtodieanyway,itwouldbewrongtoprolonghissufferingneedlessly.Butnownoticethis.Ifonesimplywithholdstreatment,itmaytakethepatientlongertodie,andsohemaysuffermorethanhewouldifmoredirectactionweretakenandalethalinjectiongiven.Thisfactprovidesastrongreasonforthinkingthat,oncetheinitialdecisionnottoprolonghisagonyhasbeenmade,activeeuthanasiaisactuallypreferabletopassiveeuthanasia,ratherthanthereverse.Tosayotherwiseistoendorsetheoptionthatleadstomoresufferingratherthanless,andiscontrarytothehumanitarianimpulsethatpromptsthedecisionnottoprolonghislifeinthefirstplace.,Part2_T4,Partofmypointisthattheprocessofbeing“allowedtodie”canberelativelyslowandpainful,whereasbeinggivenalethalinjectionisrelativelyquickandpainless.Letmegiveadifferentsortofexample.IntheUnitedStatesaboutonein600babiesisbornwithDownssyndrome.1Mostofthesebabiesareotherwisehealthythatis,withonlytheusualpediatriccare,theywillproceedtoanotherwisenormalinfancy.Some,however,arebornwithcongenitaldefectssuchasintestinalobstructionthatrequireoperationsiftheyaretolive.Sometimes,theparentsandthedoctorwilldecidenottooperate,andlettheinfantdie.AnthonyShawdescribeswhathappensthen:,Part2_T5,Part2_T6,.Whensurgeryisdeniedthedoctormusttrytokeeptheinfantfromsufferingwhilenaturalforcessapthebabyslifeaway.Asasurgeonwhosenaturalinclinationistousethescalpeltofightoffdeath,standingbyandwatchingasalvageablebabydieisthemostemotionallyexhaustingexperienceIknow.Itiseasyataconference,inatheoreticaldiscussion,todecidethatsuchinfantsshouldbeallowedtodie.Itisaltogetherdifferenttostandbyinthenurseryandwatchasdehydrationandinfectionwitheratinybeingoverhoursanddays.Thisisaterribleordealformeandthehospitalstaffmuchworsesothanfortheparentswhoneversetfootinthenursery.,Part2_T7,Icanunderstandwhysomepeopleareopposedtoalleuthanasiaandinsistthatsuchinfantsmustbeallowedtolive.IthinkIcanalsounderstandwhyotherpeoplefavordestroyingthesebabiesquicklyandpainlessly.Butwhyshouldanyonefavorletting“dehydrationandinfectionwitheratinybeingoverhoursanddays?”Thedoctrinethatsaysthatababymaybeallowedtodehydrateandwither,butmaynotbegivenaninjectionthatwouldenditslifewithoutsuffering,seemssopatentlycruelastorequirenofurtherrefutation.Thestronglanguageisnotintendedtooffend,butonlytoputthepointintheclearestpossibleway.Mysecondargumentisthattheconventionaldoctrineleadstodecisionsconcerninglifeanddeathmadeonirrelevantgrounds.,Part2_T8,ConsideragainthecaseoftheinfantswithDownssyndromewhoneedoperationsforcongenitaldefectsunrelatedtothesyndrometolive.Sometimes,thereisnooperation,andthebabydies,butwhenthereisnosuchdefect,thebabyliveson.Now,anoperationsuchasthattoremoveanintestinalobstructionisnotprohibitivelydifficult.Thereasonwhysuchoperationsarenotperformedinthesecasesis,clearly,thatthechildhasDownssyndromeandtheparentsanddoctorjudgethatbecauseofthefactitisbetterforthechildtodie.,Butnoticethatthissituationisabsurd,nomatterwhatviewonetakesofthelivesandpotentialsofsuchbabies.Ifthelifeofsuchaninfantisworthpreserving,whatdoesitmatterifitneedsasimpleoperation?Or,ifonethinksitbetterthatsuchababyshouldnotliveon,whatdifferencedoesitmakethatithappenstohaveanunobstructedintestinaltract?Ineithercase,thematteroflifeanddeathisbeingdecidedonirrelevantgrounds.ItistheDownssyndrome,andnottheintestines,thatistheissue.Themattershouldbedecided,ifatall,onthatbasis,andnotbeallowedtodependontheessentiallyirrelevantquestionofwhethertheintestinaltractisblocked.,Part2_T9,Whatmakesthissituationpossible,ofcourse,istheideathatwhenthereisanintestinalblockage,onecan“letthebabydie,”butwhenthereisnosuchdefectthereisnothingthatcanbedone,foronemustnot“kill”it.Thefactthatthisidealeadstosuchresultsasdecidinglifeordeathonirrelevantgroundsisanothergoodreasonwhythedoctrineshouldberejected.Onereasonwhysomanypeoplethinkthatthereisanimportantmoraldifferencebetweenactiveandpassiveeuthanasiaisthattheythinkkillingsomeoneismorallyworsethanlettingsomeonedie.Butisit?Iskilling,initself,worsethanlettingdie?Toinvestigatethisissue,twocasesmaybeconsideredthatareexactlyalikeexceptthatoneinvolveskillingwhereastheother,Part2_T10,Part2_T11,involveslettingsomeonedie.Then,itcanbeaskedwhetherthisdifferencemakesanydifferencetothemoralassessments.Itisimportantthatthecasesbeexactlyalike,exceptforthisonedifference,sinceotherwiseonecannotbeconfidentthatitisthisdifferenceandnotsomeotherthataccountsforanyvariationintheassessmentsofthetwocases.So,letusconsiderthispairofcases:Inthefirst,Smithstandstogainalargeinheritanceifanythingshouldhappentohissix-year-oldcousin.Oneeveningwhilethechildistakinghisbath,Smithsneaksintothebathroomanddrownsthechild,andthenarrangesthingssothatitwilllooklikeanaccident.,Part2_T12,Inthesecond,Jonesalsostandstogainifanythingshouldhappentohissix-year-oldcousin.LikeSmith,Jonessneaksinplanningtodrownthechildinhisbath.However,justasheentersthebathroomJonesseesthechildslipandhithishead,andfallfacedowninthewater.Jonesisdelighted;hestandsby,readytopushthechildsheadbackunderifitisnecessary,butitisnotnecessary.Withonlyalittlethrashingabout,thechilddrownsallbyhimself,“accidentally,”asJoneswatchesanddoesnothing.NowSmithkilledthechild,whereasJones“merely”letthechilddie.Thatistheonlydifferencebetweenthem.Dideithermanbehavebetter,fromamoralpointofview?Ifthedifferencebetweenkillingandlettingdiewereinitselfamorallyimportant,Part2_T13,matter,oneshouldsaythatJonessbehaviorwaslessreprehensiblethanSmiths.Butdoesonereallywanttosaythat?Ithinknot.Inthefirstplace,bothmenactedfromthesamemotive,personalgain,andbothhadexactlythesameendinviewwhentheyacted.ItmaybeinferredfromSmithsconductthatheisabadman,althoughthatjudgmentmaybewithdrawnormodifiedifcertainfurtherfactsarelearnedabouthimforexample,thatheismentallyderanged.ButwouldnottheverysamethingbeinferredaboutJonesfromhisconduct?Andwouldnotthesamefurtherconsiderationsalsoberelevanttoanymodificationofthisjudgment?Moreover,suppose