1、U8,Additional lnformation for the Teachers Reference,Text Active and Passive Euthanasia,Warm-up Activities,Further Reading,Writing Skills,Additional Work,Warm-up Activities,1. Try to give a definition of euthanasia. 2. Brainstorm about the pros and cons of euthanasia. 3. Collect references to this i
2、ssue and take down notes. 4. Order information and work out your own opinion.,Warm-up 1.1,James Rachels was an American professor of moral philosophy and medical ethics who was particularly concerned with ethical issues. Born in Columbus, Georgia, he earned degrees at Mercer University and the Unive
3、rsity of California before joining the University of Alabama, Birmingham Department of Philosophy faculty in 1977. The popularity of his groundbreaking textbook anthology Moral Problems (1971), which sold 100,000 copies, influenced American universities to move away from more traditional philosophic
4、ally oriented undergraduate moral philosophy courses toward more practical undergraduate courses in ethics.,AIFTTR1.1,Additional lnformation for the Teachers Reference,1. James Rachels (1941 - 2003),AIFTTR2.1,2. Euthanasia,Euthanasia is a practice of mercifully ending a persons life in order to rele
5、ase the person from an incurable disease, intolerable suffering, or undignified death. The word euthanasia derives from the Greek for “good death” and originally referred to intentional mercy killing. Proponents of euthanasia believe that unnecessarily prolonging life in terminally ill patients caus
6、es suffering to the patients and their family members. Many societies now permit passive euthanasia, which allows physicians to withhold or withdraw life-sustaining treatment when directed to do so by the patient or an authorized representative.,AIFTTR2.2,Euthanasia differs from assisted suicide, in
7、 which a patient voluntarily brings about his or her own death with the assistance of another person, typically a physician. In this case, the act is a suicide (intentional self-inflicted death), because the patient actually causes his or her own death. A. Related Laws As laws have evolved from thei
8、r traditional religious underpinnings, certain forms of euthanasia have been legally accepted. In general, laws attempt to draw a line between passive euthanasia (generally associated with allowing a person to die) and active euthanasia (generally associated with killing a person). While laws common
9、ly permit passive euthanasia, active euthanasia is typically prohibited.,AIFTTR2.3,Laws in the United States and Canada maintain the distinction between passive and active euthanasia. While active euthanasia is prohibited, courts in both countries have ruled that physicians should not be legally pun
10、ished if they withhold or withdraw a life-sustaining treatment at the request of a patient or the patients authorized representative. These decisions are based on increasing acceptance of the doctrine that patients possess a right to refuse treatment. Until the late 1970s, whether or not patients po
11、ssessed a legal right of refusal was highly disputed. One factor that may have contributed to growing acceptance of this right is the ability to keep individuals alive for long periods of time even when they are permanently unconscious or severely brain-damaged. Proponents jets,AIFTTR2.4,of legalize
12、d euthanasia believe that prolonging life through the use of modern technological advances, such as respirators and kidney machines, may cause unwarranted suffering to the patient and the family. As technology has advanced, the legal rights of the patient to forgo such technological intervention hav
13、e expanded. Every U.S. state has adopted laws that authorize legally competent individuals to make advanced directives, often referred to as living wills. Such documents allow individuals to control some features of the time and manner of their deaths. In particular, these directives empower and ins
14、truct doctors to withhold life-support systems if the individuals become terminally ill. Furthermore, the federal Patient Self-Determination Act, which became effective in 1991, requires federally certified health-care bet,AIFTTR2.5,facilities to notify competent adult patients of their right to acc
15、ept or refuse medical treatment. The facilities must also inform such patients of their rights under the applicable state law to formulate an advanced directive. Patients in Canada have similar rights to refuse life-sustaining treatments and formulate advanced directives.As of mid-1999, only one U.S
16、. state, Oregon, had enacted a law allowing physicians to actively assist patients who wish to end their lives. However, Oregons law concerns assisted suicide rather than active euthanasia. It authorizes physicians to prescribe lethal amounts of medication that patients then administer themselves.In
17、 response to modern medical technology, physicians and lawmakers are slowly developing new professional and legal definitions of death. Additionally, experts are formulating rules to bat,AIFTTR2.6,implement these definitions in clinical situations, for example, when procuring organs for transplantat
18、ion. The majority of states have accepted a definition of brain death the point when certain parts of the brain cease to function as the time when it is legal to turn off a patients life-support system, with permission from the family.In 1995 the Northern Territory of Australia became the first juri
19、sdiction to explicitly legalize voluntary active euthanasia. However, the federal parliament of Australia overturned the law in 1997. In 2001 The Netherlands became the first country to legalize active euthanasia and assisted suicide, formalizing medical practices that the government had tolerated f
20、or years. Under the Dutch law, euthanasia is justified (not legally punishable) if the must,AIFTTR2.7,physician follows strict guidelines. Justified euthanasia occurs if (1) the patient makes a voluntary, informed, and stable request; (2) the patient is suffering unbearably with no prospect of impro
21、vement; (3) the physician consults with another physician, who in turn concurs with the decision to help the patient die; and (4) the physician performing the euthanasia procedure carefully reviews the patients condition. Officials estimate that about 2 percent of all deaths in The Netherlands each
22、year occur as a result of euthanasia. B. PrevalenceAlthough establishing the actual prevalence of active euthanasia is difficult, studies suggest that the practice is not common in the United States. In a study published in 1998 in the New England Journal of Medicine, only about 6 percent of basketb
23、all,physicians surveyed reported that they had helped a patient hasten his or her own death by administering a lethal injection or prescribing a fatal dose of medication. (Eighteen percent of the responding physicians indicated that they had received requests for such assistance.) However, one-fifth
24、 of the physicians surveyed indicated that they would be willing to assist patients if it were legal to do so. No comparable data are available for Canada. However, in 1998 the Canadian Medical Association (CMA) proposed that a study of euthanasia and physician-assisted suicide be undertaken due to
25、poor information on the subject. C. Ethical Concerns The issue of euthanasia raises ethical questions for physicians and other health-care providers. The ethical code of physicians in the,AIFTTR2.8,AIFTTR2.9,United States has long been based in part on the Hippocratic Oath, which requires physicians
26、 to do no harm. However, medical ethics are refined over time as definitions of harm change. Prior to the 1970s, the right of patients to refuse life-sustaining treatment (passive euthanasia) was controversial. As a result of various court cases, this right is nearly universally acknowledged today,
27、even among conservative bioethicists (see Medical Ethics). The controversy over active euthanasia remains intense, in part because of opposition from religious groups and many members of the legal and medical professions. Opponents of voluntary active euthanasia emphasize that health-care providers
28、have professional obligations that prohibit killing. These opponents maintain that active euthanasia is inconsistent with the roles of nursing, basketball,AIFTTR2.10,caregiving, and healing. Opponents also argue that permitting physicians to engage in active euthanasia creates intolerable risks of a
29、buse and misuse of the power over life and death. They acknowledge that particular instances of active euthanasia may sometimes be morally justified. However, opponents argue that sanctioning the practice of killing would, on balance, cause more harm than benefit.Supporters of voluntary active eutha
30、nasia maintain that, in certain cases, relief from suffering (rather than preserving life) should be the primary objective of health-care providers. They argue that society is obligated to acknowledge the rights of patients and to respect the decisions of those who elect euthanasia. Supporters of ac
31、tive euthanasia contend that since society has mutual,AIFTTR2.11,acknowledged a patients right to passive euthanasia (for example, by legally recognizing refusal of life-sustaining treatment), active euthanasia should similarly be permitted. When arguing on behalf of legalizing active euthanasia, pr
32、oponents emphasize circumstances in which a condition has become overwhelmingly burdensome for a patient, pain management for the patient is inadequate, and only a physician seems capable of bringing relief. They also point out that almost any individual freedom involves some risk of abuse and argue
33、 that such risks can be kept to a minimum by using proper legal safeguards.,AIFTTR3.1,3. American Medical Association,The American Medical Association (AMA), founded in 1847 and incorporated 1897, is the largest association of physicians and medical students in the United States. It is a nonprofit p
34、rofessional association of physicians, including all medical specialties. The AMAs purpose is to promote the art and science of medicine for the betterment of the public health, to advance the interests of physicians and their patients, to promote public health, to lobby for legislation favorable to
35、 physicians and patients, to raise money for medical education and to serve as an advocate for the advancement of the profession. The Association also publishes the Journal of the American Medical Association (JAMA), which has the largest circulation of any weekly medical journal in the world. The A
36、MA also publishes a list of Physician Specialty Codes which are a standard method in the U.S. for identifying physician and practice specialties.,Text,Active and Passive Euthanasia,Notes,Introduction to the Author and the Article,Phrases and Expressions,Exercises,Main Idea of the Text,Main Idea of t
37、he Text 1,Main Idea of the Text,Rachelsessay “Active and Passive Euthanasia” first appeared in the New England Journal of Medicine in 1975. In it, Rachels argues that killing is not morally worse than letting a person die of natural causes, when done for humanitarian reasons. Therefore, active eutha
38、nasia is not any worse than passive euthanasia, and in cases where a patient is spared needless pain, arguably better.,James Rachels (1941 2003) was an American professor of moral philosophy and medical ethics who was particularly concerned with ethical issues. Born in Columbus, Georgia, he earned d
39、egrees at Mercer University and the University of California before joining the University of Alabama, Birmingham Department of Philosophy faculty in 1977. The popularity of his groundbreaking textbook anthology Moral Problems (1971), which sold 100,000 copies, influenced American universities to mo
40、ve away from more traditional philosophically oriented undergraduate moral philosophy courses toward more practical undergraduate courses in ethics.,Introduction to the Author and the article,Introduction to the Author and the Article,Rachelsessay “Active and Passive Euthanasia” first appeared in th
41、e New England Journal of Medicine in 1975. In it, Rachels argues that killing is not morally worse than letting a person die of natural causes, when done for humanitarian reasons. Therefore, active euthanasia is not any worse than passive euthanasia, and in cases where a patient is spared needless p
42、ain, arguably better.,Introduction to the Author and the article,Part2_T1,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 p
43、ermissible 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 American Medical Association on December 4, 1973:,James Rachels,Active and Passive Euthanasia,Text,The intentional termination of th
44、e 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.The cessation of the employment of extraordinary means to prolong the life of the body when there is irrefutable evidence t
45、hat biological death is imminent is the decision of the patient and/or his immediate family. The advice and judgment of the physician should be freely available to the patient and/or his immediate family.,Part2_T2,However, a strong case can be made against this doctrine. In what follows I will set o
46、ut some of the relevant arguments, and urge doctors to reconsider their views on this matter.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 d
47、ays, 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.,Part2_T3,Suppose the doctor agrees to withhold treatment, as the conventional doctrine says he m
48、ay. 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 h
49、e would if more direct action were taken and a lethal injection given. This fact provides a 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
50、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.,Part2_T4,Part of my point is that the process of being “allowed to die” can be relatively slow and painful, whereas b
51、eing 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 Downs 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 obstruction that require operations if they are to live. Sometimes, the parents and the doctor will decide not to operate, and let the infant die. Anthony Shaw describes what happens then:,
