2024年4月22日发(作者：)

UNIT TWO Active and Passive Euthanasia

[1]The distinction between active and passive euthanasia is thought to be

crucial for medical ethics. The idea is that it is permissible, at least in some cases, to

withhold treatment and allow a patient to die, but it is never permissible to take

any direct action designed to kill the patient. This doctrine seems to be accepted

by most doctors, and it is endorsed* in a statement adopted by the House of

Delegates of the American Medical Association on December 4, 1973.

The intentional termination of life of one human being by another - mercy

killing - is contrary to that for which the medical profession stands and is contrary

to the policy of the American Medical Association

①

.

The cessation* of the employment of extraordinary means to prolong* the life

of the body when there is irrefutable evidence that biological death is imminent* is

the decision of the patient and/or her immediate family

①

. The advice and

judgment of the physician should be freely available to the patient and/or his

immediate family.

However, a strong case can be made against this doctrine. In what follows I will

set out some of the relevant arguments and urge doctors to reconsider their views

on this matter.

［2］To begin with a familiar type of situation, a patient who is dying of

incurable cancer of the throat is in terrible pain, which can no longer be

satisfactorily alleviated*. He is certain to die within a few days, even if present

treatment is continued, but he does not want to go on living for those days since

the pain is unbearable. So he asks the doctor for an end to it, and his family joins in

the request.

［3］Suppose the doctor agrees to withhold treatment, as the conventional

doctrine* says he may. The justification for his doing so is that the patient is in

terrible agony*, and since he is going to die anyway, it would be wrong to prolong

his suffering needlessly. But now notice this. If one simply withholds treatment, it

may take the patient longer to die, and so he may suffer more than he would if

more direct action were taken and lethal* injection given. This fact provides strong

reason for thinking that, once the initial decision not to prolong his agony has

been made, active euthanasia is actually preferable to passive euthanasia, rather

than the reverse. To say otherwise is to endorse the option* that leads to more

suffering rather than less, and is contrary to the humanitarian impulse* that

prompts the decision not to prolong his life in the first place.

［4］Part of my point is that the process of being "allowed to die" can be

relatively slow and painful, whereas being given a lethal injection is relatively quick

and painless. Let me give a different sort of example. In the United States about

one in 600 babies is born with Down's syndrome*

①

. Most of these babies are

otherwise healthy— that is, with only the usual pediatric* care, they will proceed to

an otherwise normal infancy*. Some, however, are born with congenital* defects

such as intestinal* obstructions*

①

that require operations if they are to live.

Sometimes, the parents and doctor will decide not to operate, and let the

infant die. Anthony Shaw describes what happens then：

... When surgery is denied ［the doctor］ must try to keep the infant from

suffering while natural forces sap* the baby's life away. As a surgeon whose natural

inclination* is to use the scalpel* to fight off death, standing by and watching a

salvageable* baby die is the most emotionally exhausting experience I know. It is

easy at a conference, in a theoretical discussion, to decide that such infants should

be allowed to die. It is altogether different to stand by in the nursery and watch as

dehydration* and infection* wither a tiny being over hours and days. This is a

terrible ordeal* for me and the hospital staff - much more so than for the parents

who never set foot in the nursery.

I can understand why some people are opposed to all euthanasia, and insist

that such infants must be allowed to live. I think I can also understand why other

people favor destroying these babies quickly and painlessly. But why should

anyone favor letting "dehydration and infection wither a tiny being over hours and

days?" The doctrine that says that a baby may be allowed to dehydrate and wither

but may not be given an injection that would end its life without suffering seems

so patently* cruel as to require no further refutation*. The strong language is not

intended to offend but only to put the point in the clearest possible way.

［5］My second argument is that the conventional doctrine leads to decisions

concerning life and death made on irrelevant grounds.

［6］Consider again the case of the infants with Down's syndrome who need

operations for congenital defects unrelated to the syndrome to live. Sometimes,

there is no operation, and the baby dies, but when there is no such defect, the

baby lives on. Now, an operation such as that to remove an intestinal obstruction is

not prohibitively difficult. The reason why such operations are not performed in

these cases is, clearly, that the child has Down's syndrome and the parents and

doctor judge that because of that fact it is better for the child to die.

［7］But notice that this situation is absurd*, no matter what view one takes of

the lives and potentials of such babies. If the life of such an infant is worth

preserving, what does it matter if it needs a simple operation? Or, if one thinks it

better that such a baby should not live on, what difference does it make that it

happens to have an unobstructed intestinal tract? In either case, the matter of life

and death is being decided on irrelevant grounds. It is the Down's syndrome, and

not the intestines, that is the issue. The matter should be decided, if at all, on that

basis, and not be allowed to depend on the essentially irrelevant question of

whether the intestinal tract is blocked.

［8］What makes this situation possible, of course, is the idea that when there

is an intestinal blockage, one can "let the baby die", but when there is no such

defect, there is nothing that can be done, for one must not "kill" it. The fact that

this idea leads to such results as deciding life or death on irrelevant grounds is

another good reason why the doctrine should be rejected.

［9］One reason why so many people think that there is an important moral

difference between active and passive euthanasia is that they think killing

someone is morally worse than letting someone die. To investigate this issue, two

cases may be considered that are exactly alike except that one involves killing

whereas the other involves letting someone die. Then, it can be asked whether this

difference makes any difference to the moral assessments. It is important that the

cases be exactly alike, except for this one difference, since otherwise one cannot

be confident that it is this difference and not some other that accounts for any

variation in the assessments of the two cases. So, let us consider this pair of cases:

［10］In the first, Smith stands to gain a large inheritance* if anything should

happen to his six-year-old cousin. One evening while the child is taking his bath,

Smith sneaks into the bathroom and drowns the child, and then arranges things so

that it will look like an accident.

［11］In the second, Jones also stands to gain if anything should happen to his

six-year-old cousin. Like Smith, Jones sneaks in planning to drown the child in his

bath. However, just as he enters the bathroom Jones sees the child slip and hit his

head, and fall face down in the water. Jones is delighted; he stands by, ready to

push the child's head back under if it is necessary, but it is not necessary. With only

a little thrashing* about, the child drowns all by himself, "accidentally", as Jones

watches and does nothing.

［12］Now Smith killed the child, whereas Jones "merely" let the child die. That

is the only difference between them. Did either man behave better, from a moral

point of view? If the difference between killing and letting die were in itself a

morally important matter, one should say that Jones's behavior was less

reprehensible* than Smith's. But does one really want to say that? I think not. In the

first place, both men acted from the same motive, personal gain, and both had

exactly the same end in view when they acted. It may be inferred from Smith's

conduct that he is a bad man, although that judgment may be withdrawn or

modified if certain further facts are learned about him - for example, that he is

mentally deranged. But would not the very same thing be inferred about Jones

from his conduct? And would not the same further considerations also be relevant

to any modification of this judgment? Moreover, suppose Jones pleaded*, in his

own defense, "After all, I didn't do anything except just stand there and watch the

child drown. I didn't kill him; I only let him die." Again, if letting die were in itself

less bad than killing, this defense should have at least some weight. But it does not.

Such a "defense" can only be regarded as a grotesque perversion of moral

reasoning. Morally speaking, it is no defense at all.

［13］Now, it may be pointed out, quite properly, that the cases of euthanasia

with which doctors are concerned are not like this at all. They do not involve

personal gain or the destruction of normal healthy children. Doctors are

concerned only with cases in which the patient's life is of no further use to him, or

in which the patient's life has become or will soon become a terrible burden.

However, the point is the same in these cases: the bare difference between killing

and letting die does not, in itself, make a moral difference. If a doctor lets a patient

die, for humane* reasons, he is in the same moral position as if he had given the

patient a lethal injection for humane reasons. If his decision was wrong - if, for

example, the patient's illness was in fact curable - the decision would be equally

regrettable no matter which method was used to carry it out. And if the doctor's

decision was the right one, the method used is not in itself important.

[14] The AMA policy statement isolates the crucial issue very well; the crucial

issue is "the intentional termination of the life of one human being by another".

But after identifying this issue, and forbidding "mercy killing", the statement goes

on to deny that the cessation of treatment is the intentional termination of life.

This is where the mistake comes in, for what is the cessation of treatment, in these

circumstances, if it is not "the intentional termination of the life of one human

being by another"? Of course it is exactly that, and if it were not, there would be no

point to it ...

Ⅰ. Comprehension

Answer the following questions.

1. What is the distinction between active and passive euthanasia?

2. What is the attitude of AMA toward the problem of euthanasia?

3. What is a lethal injection? Why does the author think the doctor should give

it to the hopeless patient?

4. What is the most painful thing to do for a surgeon? Why?

5. Why are some people opposed to all kinds of euthanasia?

6. Why does the author say the conventional doctrine leads to decisions

concerning life and death made on irrelevant grounds?

7. Is killing someone morally worse than letting someone die? Can you give

any other example to prove your opinion?

8. What is the difference between the doctor's role in active euthanasia and

that of someone in a criminal case of killing?

9. Are mercy killing and conventional euthanasia the same thing? Why or why

not?

10. What is the mistake AMA made in the statement? Why is it a mistake?

Ⅱ. Vocabulary

A.

Identify one of the four choices A, B, C, or D which would keep the meaning

of the underlined word or phrase.

1. Parents heartily endorsed the plan for a school playground.

A. adored B. admired C. supported D. denied

2. Black clouds, thunder and lightning show that a storm is imminent.

A. coming B. Irremediable C. unavoidable D. irresistible

3. She had upset some boiling oil on her arm and was in agony.

A. great pain B. Suffering C. danger D. despair

4. The walls of the boathouse had been sapped away by the waves.

A. carried away B. destroyed C. washed up D. stricken

5. You must always be ready to sacrifice inclination to duty.

A. liking B. tendency C. interest D. career

6. Age had withered the old lady's face.

A. destroyed B. hurt C. made decrepit D. flecked

7. Unable to sleep, the patient thrashed about in bed.

A. twisted B. Twitched C. tossed about D. tossed off

8. The committee's plans are set out in the report made by the chairman.

A. mentioned

and clear

B. intended to do C. arranged D. made known

9. Their request was absurd and consequently rejected.

A. ridiculous B. excessive C. feasible D. harsh

was given imprisonment without the option of a fine.

A. punishment

choose

B. request C. demand D. freedom to

B.

Choose the correct answer. Only one answer is correct.

11. There was no school play because the principal ________ his consent.

A. took silence for B. withheld C. rewarded D. awarded

12. In many countries now, smoking is not ________ in public places.

A. permissive

pernicious

B. permissible C. permutable D.

13. The boy's curiosity ________ him to ask endless questions.

A. made B. helped C. confused D. prompted

14. Condemned to death, Socrates could have escaped but chose to die by

drinking ________ poison - seeking truth even to the end.

A. strong B. dead C. dying D. lethal

15. We believe in ________ treatment of prisoners so that they can turn over a

new leaf.

A. human B. humane C. cruel D. stern

16. Being a commander, he should remain calm at the ________ moment.

A. critic B. Crisp C. crucial D. crinkly

17. Health without riches is ________ to riches without health.

A. preferable B. better C. desirable D. desirous

18. The decision made by the party recently goes against everything I ________.

A. stand in with B. stand fast C. stand in awe of D. stand for

19. The ________ of ill-feeling from the Treaty of Versailles made Hitler more

determined to take revenge on France in World War Two.

A. inheritance B. result C. wish D. desire

20. Medical ________ do not permit doctors and surgeons to advertise.

A. duties B. standards C. laws D. ethics

Ⅳ. Translation

A. Put the following into Chinese.

No young man believes he shall ever die. There is a feeling of eternity in youth,

which makes us amend for everything. To be young is to be one of the Immortal

Gods. One half of time indeed is flown— the other half remains in store for us with

all its countless treasures; for there is no line drawn, and we see no limit to our

hopes and wishes. We make the coming age our own. “The vast, the unbounded

prospect lies before us.” We look round in a new world, full of life, and motion,

and ceaseless progress; and feel in ourselves all the vigor and spirit to keep pace

with it, and do not foresee from any present symptoms how we shall be left behind

in the natural course of things, decline into old age, and drop into the grave.

B. Put the following into English.

1.阅读（提供）给心灵的只是知识材料，思维才能把我们所读的东西变成自己的（东

西）。

2.建筑房屋应该使空气自由流通，且有充足的阳光照射。

3.不管干哪 一行，每个开始出来谋生的青年人只有一条安全的路好走。

4.写文章时，一定要把自己的观点仔细讲清楚。

5.虽然这样一个极端的议案通过的可能性不大，但这一事实意味着我们很快会在全国

范围内面临这个问题。

6.有人主张濒临死亡的、极端痛苦的病人应该可以要求他（或她）的医生开一个致命

的大剂量药物处方。这种主张有什么错误呢？首先，如果止痛药大量地、恰当地使用，那

么所有的病人就都能止痛了。不可否认，在有些情况下剂量不得不加得很大，以至于引起

呼吸困难导致猝死。但是，用药的目的是止痛而不是致死。如果病人由于大量用药而死亡，

这当然是一个很严重的问题。