医生杀人不犯法

　　1、The Supreme Court's decisions on physician-assisted suicide carry important implications for how medicine seeks to relieve dying patients of pain and suffering.

　　最高法庭关于医生协助病人结束生命问题的裁决，对于如何用药物减轻病危者的痛苦这个问题来说，具有重要的意义。

　　2、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.

　　尽管裁决认为，宪法没有赋予医生帮助病人自杀的权利，然而最高法庭实际上却认可了医疗界的“双效”原则，这个存在了好几个世纪的道德原则认为，如果某种行为具有双重效果(希望达到的好效果和可以预见得到的坏效果)，那么，只要行为实施只是想达到好的效果，这个行为就是可以允许的。

　　3、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."

　　近年来，医生们一直在借用这项原则，为自己替病危患者注射大剂量的吗啡镇痛的做法提供正当的理由，尽管他们知道，不断增加的剂量最终会杀死病人。蒙特非奥里医疗中心主任南希•都博勒认为，这项原则将消除部分医生的疑虑，这些医生在此之前一直强烈地认为，如果给病人充分的药品来止痛会加速他们的死亡的话那就不能这样做。

　　4、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."

　　波士顿大学健康法律系主任乔治•安纳斯坚持认为，只要医生是出于合理的医疗目的开药，那么即使服用此药会加速病人的死亡，医生的行为也没有违法。“这就像做手术，”他说，“我们不能称那些死亡为杀人是因为医生并没有想杀死病人，尽管他们敢冒病人死亡的危险。假定你是一名医生，只要你并没有想让病人自杀，你就可以去冒你的病人自杀的风险。”

　　5、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 modern medicine has prolonged the physical agony of dying.

　　另一方面，许多医疗界人士承认，致使医助自杀这场争论升温的部分原因是由于病人们的绝望情绪，对这些病人来说，现代医学延长了临终前肉体的痛苦。

　　6、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 undertreatment 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.

　　就在最高法庭对医助自杀进行裁决的前三周，全国科学学会公布了一份长达两卷的报告——临近死亡：完善临终护理。报告指出了医院临终关怀护理中存在的两个问题：对病痛处理不力和大胆使用“无效而强制性的医疗程序，这些程序可能会延长死亡期，甚至会让死亡期难堪”。

　　7、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.

　　医疗行业采取步骤，让年轻医生去晚期病人休养所培训，对各种大胆的镇痛疗法方面的知识进行评估，为医院护理制定一份符合美国医疗保障方案的付款条例，以及为评估和治疗临终痛苦制定新的标准。

　　8、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."

　　安纳斯说，律师可以在要求把医疗界的这些善意的行为变成更好的护理行动方面发挥关键作用。“不少医生对病人所遭受的毫无必要的，可预见的痛苦无动于衷”，乃至于已构成“蓄意虐待病人”。他说，行医资格理事会“必须明确表明——病人痛苦地死亡，可以推定，是由于医生处理不力造成的，应该因此吊销其从医资格”。

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