真题训练

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 modern 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 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.
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."

56. From the first three paragraphs, we learn that ________.
[A] doctors used to increase drug dosages to control their patients' pain
[B] it is still illegal for doctors to help the dying end their lives
[C] the Supreme Court strongly opposes physician-assisted suicide
[D] patients have no constitutional right to commit suicide

57. Which of the following statements is true according to the text?
[A] Doctors will be held guilty if they risk their patients' death.
[B] Modern medicine has assisted terminally ill patients in painless recovery.
[C] The Court ruled that high-dosage pain-relieving medication can be prescribed.
[D] A doctor's medication is no longer justified by his intentions.

58. According to the NAS's report, one of the problems in end-of-life care is ________.
[A] prolonged medical procedures
[B] inadequate treatment of pain
[C] systematic drug abuse
[D] insufficient hospital care

59. Which of the following best defines the word "aggressive" (line 1, paragraph 7)?
[A] Bold.
[B] Harmful.
[C] Careless.
[D] Desperate.

60. George Annas would probably agree that doctors should be punished if they ________.
[A] manage their patients incompetently
[B] give patients more medicine than needed
[C] reduce drug dosages for their patients
[D] prolong the needless suffering of the patients
难句解析
难句解析：
①The Supreme Court's decisions on physician-assisted suicide carry important implications for how medicine seeks to relieve dying patients of pain and suffering.
▲要理解本句，一定要抓住它的核心成分，主语是The Supreme Court's decisions，谓语是carry，宾语是important implications，后面有一个how引导的从句作介词for的宾语。
△该句是本文的第一段，也是第一句，因此理解本句对全文的理解很有帮助。
②Although 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.
▲该句是一个复杂句，其基本结构是although引导的状语从句后面加一个主句，其主干是the court supported the medical principle of "double effect"，后面是一个对double effect进行说明的同位语，里面又有一个holding引导的宾语从句。
△本句阅读的重点在于搞清基本句子结构。在最开始阅读时可以先不看对double effect进行修饰的成分。
③Nancy 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."
▲该句的主语是Nancy Dubler，后面有一个修饰它的同位语，句子的谓语是contends，后面有一个宾语从句，其中从句的宾语又有一个who引导的很长的定语从句。
△本句阅读的重点在于理清句子主干结构，另外对于一些词的理解也很关键。Mediation本意是“调停，调和”，此处结合上下文，它更倾向于指代医生用来缓解病人疼痛的药物，因此最好把它理解为“镇痛剂”。
④On 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.
▲该句的主语是many，谓语是acknowledge承认，后面有一个宾语从句，用的是被动语态，而其中由by引导的短语后面又有一个定语从句for whom modern medicine has prolonged the physical agony of dying来修饰前面的patients。
△本句阅读的重点在于理清句子主干结构。
⑤It 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.
▲该句的主语it，指代的是上文提到的NAS，谓语的主干结构是identifies something as something，宾语有两个并列成分the undertreatment of pain和the aggressive use of "ineffectual and forced medical procedures"，后面的一个还有个定语从句来修饰。
△本句阅读的重点在于理清句子主干结构，并且要抓住复杂宾语中的核心部分。
试题解析
试题解析：
56. [B]
此题的难度合适0.501，区分度好。
在文章第二段中有这么一句话：Although it ruled that there is no constitutional right to physician-assisted suicide，意思是：尽管裁决认为，宪法没有赋予医生帮助病人自杀的权利。也就是说，医生使用安乐死之类的助死法是违法的。因此请看B选项，刚好符合文章。至于A选项，有不少人选了，估计是看到第三段中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.然而这句话的意思是：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。而A选项的意思是，医生曾经为了控制病人的病情增加药的剂量。仔细想一下，是有区别的。原文的意思是医生注射大剂量的吗啡镇痛，而题目的意思是医生增加药的剂量。两者的区别虽然不明显，但是肯定不相同。因此排除A。然后是C选项，原文中没有提到，只是说目前在讨论，但是没有说强烈反对。然后是D选项，原理上就不对，病人自杀和法律,权利有什么关系...管天管地，管不了我上吊自尽～～～
57. [C]
此题的难度合适0.546，区分度好0.276。
这是一道总括性的题，需要以文章中的多处信息为线索。这些信息较多地集中在文章的前三段：尽管在医生帮助下的自杀是不合法的，但是最高法院认为只要医生的本意是为了减轻病人的痛苦，那么他们使用大剂量的镇痛药就是允许的。第二段中：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. 意思是：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。因此可以看出，法律是允许医生使用高剂量药剂的。因此和C选项相符。请看A选项，这个选项明显是为那些喜欢主观判断的同学准备的陷阱，如果你只从常理判断的话无疑是对的，人之初性本善嘛～～但是在文章中肯本没有提到医生会内疚....所以这种选项不能选。然后请看B选项，意思是说现代的药剂能帮助病人进行无痛的康复。但是又是在原文中毫无体现。因此A和B都是主观主义错误。最后是D选项，说医生不再按照他的目的来使用药剂。这个和原文恰恰相反，原文说的是：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。因此D选项排除。
58. [B]
此题的难度合适0.481，区分度很好0.322。
本题的答题依据是第七段的第二句话中的“the undertreatment of pain”，理解了该短语的意思，这道题也就迎刃而解了。在第六段中有这么句话： 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. 其中the undertreatment of pain表明了对待疼痛的不足，undertreatment是处理不足的意思。因此明显B选项入选。而ACD选项都是对上面这句话的无根据延伸，我看大家选C的比较多，所谓systematic drug abuse是指系统药物的滥用，但是原文只是说to the extent that it constitutes "systematic patient abuse."这就说明，和原文越像的越不是答案....更何况，题目说的是According to the NAS's report，所以内容应该在第六段找。
59. [A]
此题稍难0.279，但区分度好。
选择四个选项的考生人数比较平均。这道题考查考生根据上下文判断词义的能力。一方面考生对“aggressive”这个词的基本意思要有所了解，同时要运用上下文的信息。
60. [D]
此题的难度合适0.501，区分度不大理想。
有29.6％的考生选择A项。本题的答题依据是文章的最后一段。在这一段中，Annas对大量的医生置病人的痛苦于不顾，无端地延长病人不必要的痛苦这种行为提出了批评，认为这种行为构成了“虐待病人”，并认为这样的医生应该予以吊销行医执照。考生选择A的主要原因是受到了最后一句话中的“that are incompetently managed”的影响。在文章的最后一段中，是这么说的：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." 大体上说，Annas对大量的医生置病人的痛苦于不顾，无端地延长病人不必要的痛苦这种行为提出了批评，认为这种行为构成了“虐待病人”，并认为这样的医生应该予以吊销行医执照。因此，D选项入选。至于A选项，原文中有这么一句话that painful deaths are presumptively ones that are incompetently managed and should result in license suspension。但是，还是那句话，和原文越像的越不是答案。这个选项偷换了概念，原文中说的是 painful deaths，而题目中说的是病人。还有C选项，在原文中没有提到，虽然在前几段经常出现，但是在Annas的理论中并未体现，所以不能选。
全文翻译
全文翻译：
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。
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。
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工那就不能这样做。
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。”
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。
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”。
“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。
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”。