Unite 3  Doctor's Dilemma: Treat or Let Die？
Abigail Trafford
1。 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。 Doctor’s power to treat with an array of space—age techniques has outstripped the body's 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 technology’s 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 country’s 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 Dying
8。 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 patient’s “last 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.
weigh翻译10. More than a dozen states recognize “living 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 society’s understanding of death and dying, theory issues remain。 Example： A woman， 87， afflicted by the nervous—system disorder of Parkinson’s 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 woman's 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 bec
ause 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 Alzheimer’s disease。 After the killing, the victim’s widow said： “I think God, Jim's 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 Care
14. 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 poun
ds 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.

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