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The hospital’s dilemma医院里的困境

(2009-04-30 08:55:20)
标签:

医学伦理

伦理故事

杂谈

分类: Ethic

Dilemmas 34

The hospital’s dilemma

Dr Doe shakes her head sadly. A very sad case! John Brown had his whole life ahead of him, but now lies in the hospital bed connected to a life-support machine, apparently in a deep, deep sleep.

John has been terribly injured after a motorcycle accident, and his parents, Mr. and Mrs. Brown, are waiting for Dr Doe’s report. It will be a delicate matter. Going through to the next room, where the Browns are waiting, Dr Doe sits strategically behind the table and begins by clearing her throat:

‘I’m afraid, Mr. and Mrs. Brown, your son, has, ah, no chance of recovering any further function,’ says Dr Doe, and shuffles and squares the case study notes on the table decisively. Mr. and Mrs. Brown nod encouragingly. There is a long pause and Dr Doe, seeing some doubt on their countenances, adds ‘It is not possible to hold out any hope for recovery.’

‘but doctor, he might do, mightn’t he? There is always hope.’ Poor Mrs. Brown, she looks dreadfully tired, pale and pinched.

‘Now I don’t want to increase your grief at a time like this, Mr. and Mrs. Brown, and if I thought there was any smell hope I would certainly say so, but in my clinical judgement, there is effectively no chance of your son recovering. We can keep him on the life-support machine for longer, but at some point soon we have to make the decision about the effective allocation of resources.’

Mrs. Brown gasps and sobs, and Mr. Brown hugs her.

‘I’ll leave you a while to think about it,’ says Doe, getting up. ‘We understand Doctor,’ they say.

Some time later the hospital philosopher is brought in to talk to the Browns. Dr Gnatt is cheery fellow, who claps his hands brightly and says: ‘ well now, what do we know about this young john-was he a utilitarian – or a Kantian?

‘Oh no, Doctor,’ says Mrs. Brown, ‘our John never went to church. I’m sorry.’ And she makes a little sobbing noise. ‘I wish he had now!’

‘Ah I’m sure,’ says the philosopher, a little brightly perhaps. ‘but what I really want to know is whether we think Johnny would have had a view on the optimization of resources, you know, QALYS and so on, or perhaps would have stuck rigidly, as it were, to a few simple principles.’ Seeing the spreading bafflement on the Brown’ faces, he adds ‘It’s his philosophical position and beliefs I’m trying to get at here.’

‘Oh no, doctor, John never had any of those at all, I’m sure.’ There is another long pause. Then Dr Gnatt smiles kindly. ‘Right then,’ says the good doctor, ‘in that case I think there are really no issues that need detain us here. We simply have a decision to make: to keep the machine on for the time being – or to turn it off? And I think little chap will us answer that.’

And so saying, the good Dr Gnatt produces a coin from his pocket.

‘Right now, Mr. Brown, heads or tails?’

What should the Brow reply?

医院里的困境

兜医生伤感的摇着她的头。多么伤感的事情啊!约翰·布朗整个人生都意气风发,但他现在却躺在病床上依靠医学仪器维持生命,并且无法醒来。

约翰在一次摩托车事故中受了重伤,他的父母,布朗先生和太太,正在等候兜医生的报告。她必须小心翼翼。走到隔壁布朗夫妇正在等候的房间,兜医生坐到桌前清了清嗓子开始说道:

“布朗先生和太太,恐怕,你们的儿子,呃,所有功能都无法恢复。”兜医生一边说着,一边把诊断报告放在了桌上。布朗夫妇点了点头。经过了很长时间的停顿,兜医生看到他们脸上有些疑虑,就又说道“恢复的希望完全不存在。”

“但是,医生,他应该可以的,对吗?希望永远存在。”可怜的布朗太太说,她看上去非常的疲惫,虚弱,苍白。

“我不想加大你们的伤痛,布朗先生和太太,但是如果哪怕只有一点希望,我也一定会讲的,但是根据我的诊断,你们的儿子没有机会恢复了。我们可以通过仪器来维持他的生命,但是我们必须对资源的分配做出决定。”

布朗太太喘息并呜咽着,布朗先生搂紧了她。

“我离开一会让你们想想这件事,”兜医生起身说。“我们明白,医生。”他们说。

过了一会儿医院的哲学顾问去找布朗夫妇谈。盖特医生是一个欢快的小伙子,他拍了一下手掌然后说:“好吧,来看看我们的年轻的约翰,他是一个功利主义者还是一位康德主义者?”

“噢,不,医生。”布朗太太说,“我们的约翰从来都不去教堂。我和抱歉。”接着她用啜泣的声音说:“现在我希望他能去。”

“哈!我了解,”哲学家说,他的生意稍微小了一点。“但是我真正想知道的是是否我们可以认为约翰对优化资源有意见,我的意思是,设定生命年限等等,或者我们会被一些简单的原则所困住。”看到布朗夫妇的脸上的疑惑,他补充说:“我试图知道他的哲学立场和信仰。”

“噢,不,医生,约翰从来没有这些东西,我确定。”又过了很长时间的停顿。然后盖特医生笑了。“好吧,”这个“好”大夫说,“我想我们没有必要耽误时间。我们只需要决定:保持仪器的运行还是关掉它?我想我们可以这样来简单的回答这个问题。”

说着说着,这为“好”大夫盖特从他的口袋里掏出了一枚硬币。

“好吧,布朗先生,正面还是反面?”

布朗夫妇该如何回答

译自《101 Ethical dilemmas second edition p55-p56  by MARTIN COHEN  published by Routledge in 2007

 

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