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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 and 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 and 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 modem 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 under treatment of pain and the aggressive use of "ineffectual and forced medical procedures that may prolong and 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, and to develop new standards for assessing and 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 and 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 and should result in license suspension. " George Annas would probably agree that doctors should be punished if they ______.
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In the 1920s demand for American farm products fell, as European countries began to recover from World War I and instituted austerity (紧缩) programs to reduce their imports. The result was a sharp drop in farm prices. This period was more disastrous for farmers than earlier times had been, because farmers were no longer self-sufficient. They were paying for machinery, seed, and fertilizer, and they were also buying consumer goods. The prices of the items farmers bought remained constant, while prices they received for their products fell. These developments were made worse by the Great Depression, which began in 1929 and extended throughout the 1939s.In 1929, under President Herbert Hoover, the Federal Farm Board was organized. It established the principle of direct interference with supply and demand, and it represented the first national commitment to provide greater economic stability for farmers.President Hoover"s successor attached even more importance to this problem. One of the first measures proposed by President Franklin Roosevelt when he took office in 1933 was theAgricultural Adjustment Act, which was subsequently passed by Congress. This law gave the Secretary of Agriculture the power to reduce production through voluntary agreements with farmers who were paid to take their land out of use. A deliberate scarcity of farm products was planned in an effort to raise prices. This law was declared unconstitutional by the Supreme Court on the grounds that general taxes were being collected to pay one special group of people. However, new laws were passed immediately that achieved the same result of resting soil and providing flood-control measures, but which were based on the principle of soil conservation. The Roosevelt Administration believed that rebuilding the nation"s soil was in the national interest and was not simply a plan to help farmers at the expense of other citizens. Later the government guaranteed loans to farmers so that they could buy farm machinery, hybrid (杂交) grain, and fertilizers. The Agricultural Adjustment Act encouraged American farmers to ______.
The media can impact current events. As a graduate student at Berkeley in the 1960s, I remember experiencing the events related to the People"s Park that were occurring on campus. Some of these events were given national media coverage in the press and on TV. I found it interesting to compare my impressions of what was going on with perceptions obtained from the news media. I could begin to see events of that time feed on news coverage. This also provided me with some healthy insights into the distinctions between these realities.Electronic media are having a greater impact on the people"s lives every day. People gather more and more of their impressions from representations. Television and telephone communications are linking people to a global village, or what one writer calls the electronic city. Consider the information that television brings into your home every day. Consider also the contact you have with others simply by using telephone. These media extend your consciousness and your contact. For example, the video coverage of the 1989 San Francisco earthquake focused on "live action" such as the fires or the rescue efforts. This gave the viewer the impression of total disaster. Television coverage of the Iraqi War also developed an immediacy. CNN reported events as they happened. This coverage was distributed worldwide. Although most people were far away from these events, they developed some perception of these realities.In 1992, many people watched in horror as riots broke out on a sad Wednesday evening in Los Angeles, seemingly fed by video coverage from helicopters. This event was triggered by the verdict (裁定) in the Rodney King beating. We are now in an age where the public can have access to information that enables it to make its own judgments, and most people, who had seen the video of this beating, could not understand how the jury (陪审团) was able to acquit (宣布无罪) the policemen involved. Media coverage of events as they occur also provides powerful feedback that influences events. This can have harmful results, as it seemed on that Wednesday night in Los Angeles. By Friday night the public got to see Rodney King on television pleading, "Can we all get along" By Saturday, television seemed to provide positive feedback as the Los Angeles riot turned out into a rally for peace. The television showed thousands of people marching with banners and cleaning tools. Because of that, many more people turned out to join the peaceful event they saw unfolding (展开) on television. The real healing, of course, will take much longer, but electronic media will continue to be a part of that process. The 1992 Los Angeles riots broke out because ______.
A new examination of urban policies has been carded out recently by Patricia Romero Lankao. She is a sociologist specializing in climate change and 1 development. She warns that many of the world"s fast-growing urban areas, 2 in developing countries, will likely suffer from the impacts of changing climate. Her work also concludes that most cities are failing to 3 emissions of carbon dioxide and other greenhouse 4 These gases are known to have great 5 on the atmosphere. "Climate change is a deeply local issue and 6 profound threats to the growing cities of the world," says Romero Lankao, "But too few cities are developing effective strategies to 7 their residents. "Cities are 8 sources of greenhouse gases. And urban populations are likely to be among those most severely affected by future climate change. Lankao"s findings highlight ways in which city-residents are particularly vulnerable, and suggest policy interventions that could offer immediate and longer-term 9 .The locations and dense construction patterns of cities often place their populations at greater risk for natural disasters. Potential 10 associated with climate include storm surges and prolonged hot weather. Storm surges can flood coastal areas and prolonged hot weather can heat 11 paved cities more than surrounding areas. The impacts of such natural events can be 12 serious in an urban environment. For example, a prolonged heat wave can increase existing levels of air pollution, causing widespread health problems. Poorer neighborhoods that may 13 basic facilities such as drinking water or a dependable network of roads, are especially vulnerable to natural disasters. Many residents in poorer countries live in substandard housing 14 access to reliable drinking water, roads and basic services.Local governments, 15 , should take measures to protect their residents. "Unfortunately, they tend to move towards rhetoric 16 meaningful responses," Romero Lankao writes, "They don"t impose construction standards 17 could reduce heating and air conditioning needs. They don"t emphasize mass transit and reduce 18 use. In fact, many local governments are taking a hands-off approach (不插手的政策)." Thus, she urges them to change their 19 policies and to take strong steps to prevent the harmful effects of climate change 20 cities.
New knowledge and sophisticated diagnostic techniques are helping doctors recognize early signs of autism, Alzheimer"s disease and heart problems in women. Harvard experts report on the advances that are giving patients hope.Early diagnosis of autism is critical because educational programs that build upon a child"s strengths and improve social skills may help sculpt the developing brain, minimizing the impact of the illness later in life. But spotting the disorder is hard since there is no test for it, although scientists are slowly uncovering gene abnormalities that make children vulnerable to autism. Last week The New England Journal of Medicine reported that a specific location on chromosome 16 was the site of mutations responsible for some cases of autism.For now, diagnosis depends on observing a child"s behavior. It"s a complex process, since no two cases are alike and signs range from mild to severe. Indeed, even though signs of autism may be apparent before their first birthday, most children aren"t diagnosed until the age of 3. That makes parents, who are so intimately familiar with their child"s behavior, perhaps the most effective diagnostic "tools". The American Academy of Pediatrics recently issued screening guidelines recommending that pediatricians engage parents in evaluating infants for autism. Even babies developing typically, the guidelines say, should be screened at set intervals, such as during the 9-, 18- and 24-month visits.Alzheimer"s disease, which begins years, even decades, before it causes symptoms, is a quietly ticking time bomb. But until recently doctors had no diagnostic test that could "hear" the ticking. Unfortunately, it didn"t matter much that Alzheimer"s couldn"t be spotted early—at a stage called mild cognitive impairment, or MCI—since there were no treatments. Today, however, there are new diagnostic tests that can detect Alzheimer"s at an early stage, and several disease-modifying drugs are in advanced clinical trials.The brain shrinkage caused by Alzheimer"s can now be measured with volumetric magnetic resonance imaging (MRI). This technique takes a series of MRI brain scans and then uses sophisticated mathematical models to analyze the results. Most important, volumetric MRI enables researchers to identify subtle shrinkage in brain areas first affected by Alzheimer"s, such as the hippocampus, which is involved in memory.Another technology in limited clinical use is fluoro-deoxy-glucose positron emission tomography (FDG-PET). Images produced by FDG-PET reveal patterns of glucose metabolism in the cerebral cortex, the site of abstract thought, reasoning and learning. Because active neurons guzzle glucose for energy, diminished uptake in a specific pattern can denote Alzheimer"s. In the research setting, scientists have even used FDG-PET to identify people who do not yet have Alzheimer"s but are at risk for developing it, or for developing mild cognitive impairment.Although all these new imaging and biochemical developments are individually promising, the combination of several different imaging tests and biochemical markers may yield the most accurate diagnosis. For example, scientists at the New York University School of Medicine have reported that combining volumetric MRI of the hippocampus with spinal-fluid measures improved diagnostic accuracy in identifying people with mild cognitive impairment who are most likely to progress to Alzheimer"s.When it comes to diagnosing the most common kind of heart disease, some cardiologists share Henry Higgins"s lament in "My Fair Lady": "Why can"t a woman be more like a man" That"s because many women don"t have the typical symptoms, like crushing chest pain and shortness of breath brought on by physical activity or stress. Instead, they have diffuse discomfort in the chest, unusual exhaustion or depression without an apparent reason. To make matters worse, the tests considered best at diagnosing coronary-artery disease generally don"t work as well for women as they do for men. As a result, an alarming number of women with heart disease go undiagnosed and untreated despite repeated visits to the doctor and the emergency room.A. because there still exists no test for diagnosis by nowB. because many women don"t have the typical symptoms like men for diagnosisC. the pattern of glucose metabolismD. with volumetric magnetic resonance imagingE. the most efficient technology for diagnosing Alzheimer is combination of different technologiesF. those babies without autism when they start to say single words by 16 monthsG. the symptoms of heart disease often result from cholesterol-filled plaques. Those images produced by FDG-PET can reveal ______.
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