研究生公共英語教材閱讀B第3、4、10、11、14課文原文及翻譯.doc

Unite 3 Doctors Dilemma: Treat or Let Die?Abigail Trafford1. Medical advances in wonder drugs, daring surgical procedures, radiation therapies, and intensive-care units have brought new life to thousands of people. Yet to many of them, modern medicine has become a double-edged sword.2. Doctors power to treat with an array of space-age techniques has outstripped the bodys capacity to heal. More medical problems can be treated, but for many patients, there is little hope of recovery. Even the fundamental distinction between life and death has been blurred.3. Many Americans are caught in medical limbo, as was the South Korean boxer Duk Koo Kim, who was kept alive by artificial means after he had been knocked unconscious in a fight and his brain ceased to function. With the permission of his family, doctors in Las Vegas disconnected the life-support machines and death quickly followed.4. In the wake of technologys advances in medicine, a heated debate is taking place in hospitals and nursing homes across the country - over whether survival or quality of life is the paramount goal of medicine.5. “It gets down to what medicine is all about, ” says Daniel Callahan, director of the Institute of Society, Ethics, and the Life Sciences in Hastings-on-Hudson, New York. “Is it really to save a life? Or is the larger goal the welfare of the patient?”6. Doctors, patients, relatives, and often the courts are being forced to make hard choices in medicine. Most often it is at the two extremes of life that these difficulty ethical questions arise - at the beginning for the very sick newborn and at the end for the dying patient.7. The dilemma posed by modern medical technology has created the growing new discipline or bioethics. Many of the countrys 127 medical schools now offer courses in medical ethics, a field virtually ignored only a decade ago. Many hospitals have chaplains, philosophers, psychiatrists, and social workers on the staff to help patients make crucial decisions, and one in twenty institutions has a special ethics committee to resolve difficult cases.Death and Dying8. Of all the patients in intensive-care units who are at risk of dying, some 20 percent present difficult ethical choices - whether to keep trying to save the life or to pull back and let the patient die. In many units, decisions regarding life-sustaining care are made about three times a week.9. Even the definition of death has been changed. Now that the heart-lung machine can take over the functions of breathing and pumping blood, death no longer always comes with the patients “l(fā)ast gasp” or when the heart stops beating. Thirty-one states and the District of Columbia have passed brain-death statutes that identify death as when the whole brain ceases to function.10. More than a dozen states recognize “l(fā)iving wills” in which the patients leave instructions to doctors not to prolong life by feeding them intravenously or by other methods if their illness becomes hopeless. A survey of California doctors showed that 20 to 30 percent were following instructions of such wills. Meanwhile, the hospice movement, which its emphasis on providing comfort - not cure - to the dying patient, has gained momentum in many areas.11. Despite progress in societys understanding of death and dying, theory issues remain. Example: A woman, 87, afflicted by the nervous-system disorder of Parkinsons disease, has a massive stroke and is found unconscious by her family. Their choices are to put her in a nursing home until she dies or to send her to a medical center for diagnosis and possible treatment. The family opts for a teaching hospital in New York city. Tests show the womans stroke resulted from a blood clot that is curable with surgery. After the operation, she says to her family: “Why did you bring me back to this agony?” Her health continues to worsen, and two years later she dies.12. On the other hand, doctors say prognosis is often uncertain and that patients, just because they are old and disabled, should not be denied life-saving therapy. Ethicists also fear that under the guise of medical decision not to treat certain patients, death may become too easy, pushing the country toward the acceptance of euthanasia.13. For some people, the agony of watching high-technology dying is too great. Earlier this year, Woodrow Wilson Collums, a retired dairyman from Poteet, Texas, was put on probation for the mercy killing of his older brother Jim, who lay hopeless in his bed at a nursing home, a victim of severe senility resulting from Alzheimers disease. After the killing, the victims widow said: “I think God, Jims out of his misery. I hate to think it had to be done the way it was done, but I understand it. ”Crisis in Newborn Care14. At the other end of the life span, technology has so revolutionized newborn care that it is no longer clear when human life is viable outside the womb. Newborn care has got huge progress, so it is absolutely clear that human being can survive independently outside the womb. Twenty-five years ago, infants weighting less than three and one-half pounds rarely survived. The current survival rate is 70 percent, and doctors are “salvaging” some babies that weigh only one and one-half pounds. Tremendous progress has been made in treating birth deformities such as spina bifida. Just ten years ago, only 5 percent of infants with transposition of the great arteries - the congenital heart defect most commonly found in newborns - survived. Today, 50 percent live.15. Yet, for many infants who owe their lives to new medical advances, survival has come at a price. A significant number emerge with permanent physical and mental handicaps.16. “The question of treatment and nontreatment of seriously ill newborns is not a single one,” says Thomas Murray of the Hastings Center. “But I feel strongly that retardation or the fact that someone is going to be less than perfect is not good grounds for allowing an infant to die.”17. For many parents, however, the experience of having a sick newborn becomes a lingering nightmare. Two years ago, an Atlanta mother gave birth to a baby suffering from Downs Syndrome, a form of mental retardation; the child also had blocked intestines. The doctors rejected the parents plea not to operate, and today the child, severely retarded, still suffers intestinal problems.18. “Every time Melanie has a bowel movement, she cries,” explains her mother. “Shes not able to take care of herself, and we wont live forever. I wanted to save her from sorrow, pain, and suffering. I dont understand the emphasis on life at all costs, and Im very angry at the doctors and the hospital. Who will take care of Melanie after were gone? Where will you doctors be then?”Changing Standards19. The choices posed by modern technology have profoundly changed the practice of medicine. Until now, most doctors have been activists, trained to use all the tools in their medical arsenals to treat disease. The current trend is toward nontreatment as doctors grapple with questions not just of who should get care but when to take therapy away.20. Always in the background is the threat of legal action. In August, two California doctors were charged with murdering a comatose patient by allegedly disconnecting the respirator and cutting off food and water. In 1981, a Massachusetts nurse was charged with murdering a cancer patient with massive doses of morphine but was subsequently acquitted.21. Between lawsuits, government regulations, and patients rights, many doctors feel they are under siege. Modern technology actually has limited their ability to make choices. More recently, these actions are resolved by committees.Public Policy22. In recent years, the debate on medical ethics has moved to the level of national policy. “Its just beginning to hit us that we dont have unlimited resources,” says Washington Hospital Centers Dr. Lynch. “You cant talk about ethics without talking ethics without talking about money.”23. Since 1972. Americans have enjoyed unlimited access to a taxpayer-supported, kidney dialysis program that offers life-prolonging therapy to all patients with kidney failure. To a number of police analysts, the program has grown out of control - to a $1.4billion operation supporting 61,000 patients. The majority are over 50, and about a quarter have other illness, such as cancer or heart disease, conditions that could exclude them from dialysis in other countries.24. Some hospitals are pulling back from certain lifesaving treatment. Massachusetts General Hospital, for example, has decided not perform heart transplants on the ground that the high costs of providing such surgery help too few patients. Burn units - through extremely effective - also provide very expensive therapy for very few patients.25. As medical scientists push back the frontiers of therapy, the moral dilemma will continue to grow for doctors and patients alike, making the choice of to treat the basic question in modern medicine.1. 在特效藥、風(fēng)險(xiǎn)性手術(shù)進(jìn)程、放療法以及特護(hù)病房方面的醫(yī)學(xué)進(jìn)展已為數(shù)千人帶來新生。然而，對(duì)于他們中不少人而言，現(xiàn)代醫(yī)學(xué)已成為一把雙刃劍。 2. 醫(yī)生采用一系列航空時(shí)代技術(shù)進(jìn)行治療的能力已超過人體本身的治愈能力。從醫(yī)學(xué)的角度來說，有更多的疾病能夠得以診治，可對(duì)于許多病人而言，復(fù)原的希望卻微乎其微。甚至生死之間的基本差別也難以界定清楚。 3. 不少美國人身陷醫(yī)學(xué)囹圄，形同南韓拳擊手金得九（Duk Koo Kim）的境遇。金得九在一次打斗中受到重?fù)?，人事不省，大腦停止運(yùn)轉(zhuǎn)，只能依靠人為方法賴以存活。經(jīng)其家人允許，拉斯維加斯的醫(yī)生切斷了維持其生命的器械，死神便接踵而來。 4. 醫(yī)療技術(shù)進(jìn)步了，是力求生存還是注重生命質(zhì)量，哪個(gè)目標(biāo)更為重要，這一問題在全美的醫(yī)院和療養(yǎng)院里引發(fā)了激烈的爭論。 5. “歸根結(jié)底，問題在于，醫(yī)療的宗旨是什么？”位于紐約哈德遜河上黑斯廷斯的社會(huì)、倫理及生命科學(xué)學(xué)會(huì)主席丹尼爾卡拉漢說，“是真的要挽救生命還是要為病人謀取更大的利益？” 6. 醫(yī)生、病患、家屬，通常還有法庭都不得不在醫(yī)療方面作出艱難的抉擇。而這些道德難題往往最容易產(chǎn)生于生命的兩個(gè)極端生命開初的重病新生兒和生命終端的垂死病患。 7. 這些因現(xiàn)代醫(yī)學(xué)技術(shù)而產(chǎn)生的兩難問題已不斷催生出生物倫理學(xué)的新準(zhǔn)則。如今，全美 127 家醫(yī)學(xué)院中已有不少機(jī)構(gòu)開設(shè)了醫(yī)學(xué)倫理學(xué)課程，要在十年前，根本沒人會(huì)去注意這個(gè)領(lǐng)域。不少醫(yī)院的員工隊(duì)伍都包含了牧師、哲學(xué)家、精神病醫(yī)師以及社會(huì)工作者，以求幫助病人作出關(guān)鍵性抉擇，而有二十分之一的機(jī)構(gòu)專門成立了倫理委員會(huì)解決這些難題。 8. 在所有特護(hù)病房的垂死病人當(dāng)中，有約莫 20%的病例，其當(dāng)事人面臨艱難的道德抉擇是繼續(xù)盡力挽救生命還是改變初衷、聽?wèi){病患死去。對(duì)于是否要維持生命的治療，不少病房每周大約要作三次決定。 9. 現(xiàn)在就連死亡的定義也已經(jīng)改變。既然人工心肺機(jī)能夠代替心肺維持人的呼吸和血液循環(huán)，死神往往不會(huì)隨著病患的“最后一絲喘息”或是心臟停止跳動(dòng)而如期而至。因此，哥倫比亞特區(qū)以及美國三十一個(gè)州已經(jīng)通過了腦死亡法，將死亡界定為“大腦停止運(yùn)轉(zhuǎn)”。 10. 十幾個(gè)州認(rèn)可病患的“生存意愿”，即病患指示醫(yī)生，如果病癥醫(yī)治無望則通過靜脈注射或其他方式中止其生命。針對(duì)加州醫(yī)生的一項(xiàng)調(diào)查表明，20%到 30%的醫(yī)生遵循這樣的意愿。與此同時(shí)，一項(xiàng)重在為晚期病人提供臨終關(guān)懷而非救治的安養(yǎng)活動(dòng)在許多地區(qū)頗有發(fā)展勢頭。 11. 盡管社會(huì)對(duì)于生死的理解有所進(jìn)步，棘手的問題仍然存在。例如：一位 87歲的老嫗因受帕金森氏病神經(jīng)系統(tǒng)紊亂病痛的折磨，嚴(yán)重中風(fēng)，家人發(fā)現(xiàn)她已昏迷不醒。他們需作出決定：是將她安置在療養(yǎng)院直至去世，還是將其送往醫(yī)療中心進(jìn)行診斷、盡力救治。其家人選擇了紐約城的一家教學(xué)醫(yī)院。經(jīng)檢查發(fā)現(xiàn)，中風(fēng)是由血管中的凝塊引起的，可通過手術(shù)進(jìn)行治療。術(shù)后，她蘇醒過來，卻對(duì)自己的家人說：“你們?yōu)槭裁匆獙⑽規(guī)Щ赝纯嗟纳顪Y？”她的健康狀況每況愈下，兩年后便告別人世。 12. 另一方面，醫(yī)生們表明，僅僅根據(jù)癥狀就對(duì)疾病結(jié)果作出預(yù)測往往是不確定的，而病患如果只是年老或是傷殘的話，就應(yīng)該給予挽救生命的治療。倫理學(xué)家也擔(dān)心，有了對(duì)某些特定疾病不予治療的決定做幌子，死亡可能會(huì)變得太容易了，會(huì)將整個(gè)國家推至接受安樂死的境地。 13. 對(duì)于某些人而言，看見別人依賴高科技術(shù)維持生命是極端痛苦的。今年早些時(shí)候，一位來自德州波提特從事乳品加工的退休工人伍德羅威爾遜科勒姆因?qū)ζ湫珠L吉姆實(shí)施了安樂死而被判緩刑。吉姆不幸患有早老性癡呆癥，昏聵糊涂的他只能無助地躺在療養(yǎng)院的床上。在病患安樂死之后，他的遺孀說：“我感謝上帝，吉姆脫離了苦海。想到不得不用這種方式結(jié)束他的生命，我就特別難受，可我對(duì)此表示理解?！?14. 新生兒治療危機(jī)在生命中的另一端，科技發(fā)展變革了新生兒救治技術(shù)，我們也不清楚人的生命何時(shí)可以在子宮外得以存活。二十五年前，體重不足 3.5 磅的嬰兒幾乎難以存活。如今的存活率竟然高達(dá) 70%，而且醫(yī)生們還要“搶救”體重僅有 1.5 磅重的嬰兒。在治療諸如脊柱裂之類的新生兒畸形方面已經(jīng)取得了重大進(jìn)展。就在十年前，只有 5%患有大動(dòng)脈轉(zhuǎn)位的新生兒可以存活下來該病為新生兒最為常見的先天性心臟缺陷。而如今，該病的存活率卻高達(dá) 50%。 15. 不過對(duì)于那些借助醫(yī)學(xué)新進(jìn)展而得以存活的嬰兒而言，存活是要付出代價(jià)的。許多存活者都患有永久性的生理或心理殘疾。 16. “對(duì)于重病新生兒進(jìn)行治療還是放棄治療，這不是一個(gè)單純的問題?！焙谒雇⑺怪行牡耐旭R斯默里說，“但我堅(jiān)持認(rèn)為，那種智力遲鈍、有缺陷不足以成為任由一個(gè)嬰兒死亡的理據(jù)?！?17. 然而，對(duì)于許多父母而言，養(yǎng)育患病新生兒的經(jīng)歷已成為揮之不去的噩夢。兩年前，一位亞特蘭大的母親生下一個(gè)身患唐氏綜合征的嬰兒；這個(gè)孩子還患了結(jié)腸。醫(yī)生們拒絕了家長不實(shí)施手術(shù)的懇求，而如今這個(gè)孩子，嚴(yán)重智力癡呆，仍然飽受腸病折磨。 18. “每次梅勒妮腹瀉的時(shí)候，她會(huì)嚎啕大哭，”其母親解釋說?！八畈荒茏岳恚覀兛偛荒荛L生不死照顧她一輩子吧。我想將她從苦痛折磨中解救出來。我不明白為什么要不惜一切代價(jià)地強(qiáng)調(diào)活命。對(duì)醫(yī)生和醫(yī)院的做法我真是氣壞了。我們覺得，不再維持她的生命對(duì)她而言是最好的解脫。那些醫(yī)生有悖常理。我質(zhì)問那些出言威脅如果反對(duì)其實(shí)施手術(shù)就會(huì)把我們送上法庭的醫(yī)生：我們死后誰來照顧梅勒妮？那時(shí)候你們這些醫(yī)生會(huì)在哪里？” 19. 改變準(zhǔn)則現(xiàn)代技術(shù)為人們提供了選擇，進(jìn)而從根本上改變了醫(yī)療的慣常做法。時(shí)至今日，大多數(shù)的醫(yī)生都比較激進(jìn)，他們訓(xùn)練有素，動(dòng)用一切醫(yī)療器械醫(yī)治疾病。如今，醫(yī)生們需要解決的問題不僅僅是誰應(yīng)該接受治療，還包括應(yīng)該何時(shí)終止治療，這引發(fā)了不予治療的趨向。 20. 往往來自法律的威脅也是導(dǎo)致這種趨向的原因。八月份，兩位加州醫(yī)生被控謀殺了一名昏迷不醒的病人，據(jù)說他們切斷了呼吸器，停止了病患的食物水源供應(yīng)。1981 年，一位馬薩諸塞州的護(hù)士被控為一名癌癥病人注射大量嗎啡致其死亡，而此后她被宣告無罪。 21. 不少醫(yī)生深感自己身陷訴訟案件、政府法規(guī)和病患權(quán)益的交相圍困當(dāng)中。現(xiàn)代技術(shù)的確禁錮了他們的決策能力。最近幾年，這些訴訟裁決均交由委員會(huì)解決。 22. 公眾措施最近幾年，關(guān)于醫(yī)療倫理規(guī)范的爭執(zhí)已經(jīng)上升到了國家政策的層次?！斑@才讓我們幡然醒悟，我們沒有取之不盡的資源。”華盛頓醫(yī)院中心的醫(yī)生林奇說，“說到倫理道德，就自然要談到錢。” 23. 自 1972 年以來，美國腎衰竭患者均可以參與由納稅人所支持的腎透析治療項(xiàng)目，該項(xiàng)目為所有腎衰竭病患提供了延續(xù)生命的療法。許多政策分析員認(rèn)為，該計(jì)劃已經(jīng)失控它亟需14億美元的資金來支持6萬 1千名病患。大多數(shù)病患都年逾五十，而約莫四分之一的人患有諸如癌癥或是心臟病之類的其他疾病，有這種情況的病人在別的國家是不可能做腎透析的。 24. 一些醫(yī)院正在撤銷某些挽救生命的治療項(xiàng)目。比方說，馬薩諸塞州總醫(yī)院已經(jīng)決定不再實(shí)施心臟移植手術(shù)，理由是此類手術(shù)所需費(fèi)用高昂，受助的病患寥寥無幾。燒傷診治病房盡管成效尤為顯著也只能對(duì)極少的病人提供昂貴的治療。 25. 當(dāng)醫(yī)學(xué)家正在向治療的尖端領(lǐng)域推進(jìn)之時(shí)，醫(yī)生和病患等相關(guān)人士仍將面臨越來越多的道德兩難境地，致使繼續(xù)治療還是放棄治療的抉擇成為現(xiàn)代醫(yī)學(xué)的一個(gè)基本問題。Unit 4 The Cultural Patterning of Space Joan Y Gregg1. Space is perceived differently in different cultures. Spatial consciousness in many Western cultures is based on a perception of objects in space, rather than of space itself. Westerners perceive shapes and dimensions, in which space is a realm of light, color, sight, and touch. Benjamin L. Whorf, and his classic work Language, Thought and Reality, offers the following explanation as one reason why Westerners perceive space in this manner. Western thought and language mainly developed from the Roman, Latin-speaking culture, which was a practical, experience-based system. Western culture has generally followed Roman thought patterns in viewing objective “reality” as the foundation for subjective or “inner” experience. It was only when the intellectually crude Roman culture became influenced by the abstract thinking of Greek culture that the Latin language developed a significant vocabulary of abstract, nonspatial terms. But the early Roman-Latin element of spatial consciousness, of concreteness, has been maintained in Western thought and language patterns, even though the Greek capacity for abstract thinking and expression was also inherited.2. However, some cultural-linguistic systems developed in the opposite direction, that is, from an abstract and subjective vocabulary to a more concrete one. For example, Whorf tells us that in the Hopi language the word heart, a concrete term, can be shown to be a late formation from the abstract terms think or remember. Similarly, although it seems to Westerners, and especially to Americans, that objective, tangible “reality” must precede any subjective or inner experience, in fact many Asian and other non-European cultures view inner experience as the basis for ones perceptions of physical reality. Thus although Americans are taught to perceive and react to the arrangement of objects in space and to think of space as being “wasted” unless it is filled with objects, the Japanese are trained to give meaning to space itself and to value “empty” space. For example, in many of their arts such as painting, garden design, and floral arrangements, the chief quality of composition is that essence of beauty the Japanese call shibumi. A painting that shows everything instead of leaving something unsaid is without shibumi. The Japanese artist will often represent the entire sky with one brush stroke or a distant mountain with one simple contour linethis is shibumi. To the Western eye, however, the large areas of “empty” space in such paintings make them look incomplete.3. It is not only the East and the West that are different in their patterning of space. We can also see cross-cultural varieties of spatial perception when we look at arrangements of urban space in different Western cultures. For instance, in the United States, cities are usually laid out along a grid, with the axes generally north/south and east/west. Streets and buildings are numbered sequentially. This arrangement, of course, makes perfect sense to Americans. When Americans walk in a city like Paris, which is laid out with the main streets radiating from centers, they often get lost. Furthermore, streets in Paris are named, not numbered, and the names often change after a few blocks. It is amazing to Americans how anyone gets around, yet Parisians seem to do well. Edward Hall, in The Silent Language, suggests that the layout of space characteristic of French cities is only one aspect of the theme of centralization that characterizes French culture. Thus Paris is the center of France, French government and educational systems are highly centralized, and in French offices the most important person has his or her desk in the middle of the office.4. Another aspect of the cultural patterning of space concerns he functions of spaces. In middle-class America, specific spaces are designated for specific activities. Any intrusion of one activity into a space that it was not designed for is immediately felt as inappropriate. In contrast, in Japan, this is not true: walls are movable, and rooms are used for one purpose during the day and another purpose in the evening and at night. In India there is yet another culturally patterned use of space. The function of space in India, both in public and in private places, is connected with concepts of superiority and inferiority. In Indian cities, villages, and even within the home, certain spaces are designated as polluted, or inferior, because of the activities that take place there and the kinds of people who use such space. Spaces in India are segregated so that high caste and low caste, males and females, secular and sacred activities are kept apart. This pattern has been used for thousands of years, as demonstrated by the archaeological evidence uncovered in ancient Indian cities. It is a remarkably persistent pattern, even in modern India, where public transportation reserves a separate space for women. For example, Chandigarh is a modern Indian city designed by a French architect. The apartments were built according to European concepts, but the Indians living there found certain aspects inconsistent with their previous use of living space. Ruth Freed, an anthropologist who worked in India, found that Indian families living in Chandigarh modified their apartments by using curtains to separate the mens and womens spaces. The families also continued to eat in the kitchen, a traditional pattern, and the living/dining room was only used when Western guests were present. Traditional Indian village living takes place in an area surrounded by a wall. The courtyard gives privacy to each residence group. Chandigarh apartments, however, were built with large windows, reflecting the European value