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氨基甙类抗生素+骨骼肌松弛剂（）
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非去极化型骨骼肌松弛药的特点是
氨基糖苷类抗生素和乙醚能增强和延长肌松作用
过量中毒可用新斯的明解救
骨骼肌松弛前无肌兴奋现象
选择性激动N2受体
具有不同程度神经节阻断作用
氨基糖苷类抗生素+骨骼肌松弛药:
增加肾脏毒性
增加耳毒性
增强抗菌作用,扩大抗菌谱
增加神经肌肉阻断作用
氨基糖苷类抗生素+骨骼肌松弛药
增加肾毒性
增加耳毒性
延缓耐药性产生
增强抗菌范围
增加神经—肌肉接头阻滞
氨基糖苷类抗生素+骨骼肌松弛药
增加肾毒性
增加耳毒性
延缓耐药性产生
增强抗菌范围
增加神经-肌肉接头阻滞
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InspiteofrisingconcernintheNortheastandCanadaAdministrationspokesmenhaverepeatedlyinsistedthatnothingcouldreallybedoneaboutacidrainandtheindustry-producedsulfuremissionsuntilallthescientificfactswerein.Suddenlylastweekhoweverfactscamerainingdownineffectmakingfurtherscientificdebateonwhatmainlycausestheproblemallbutirrelevant. WhatbroughtaboutthedownpourwasastudycommissionedbyPresidentialScienceAdviser.Thespokesmenplainlycalledforremedialactionevenifsometechnicalquestionsaboutacidrainwerestillunanswered.Ifwetaketheconservativepointofviewthatwemustwaituntilthescientificknowledgeisdefinitivesaidthespokesmantheaccumulateddepositionanddamagedenvironmentmayreachthepointof’’irreversibility’’. Whenitrainsitpours.NextcameastudyfromtheNationalResearchCouncil.Itsdefinitiveconclusion:reducingemissionsofsulfurdioxidefromcoal-burningpowerplantsandfactoriessuchastheseintheMidwestwouldinfactsignificantlyreducetheacidityinrainsnowandotherprecipitation降水thatiswidelybelievedtobeworseningthelifefromfresh-waterlakesandforestsintheNortheastandCanada.Thespokesmandidnotrecommendanyspecificaction. ApairofremedialmeasuresarealreadytakenbeforeCongress.ASenatecommitteerecentlyapprovedabillthatwouldrequirereductionoverthenextdecadeofsulfur-dioxideemissionsby10milliontonsintheStatesborderingontheeastoftheMississippi.AtoughermeasurewasintroducedintheHouseorderingthe50largestsulfurpollutersintheU.S.tocutemissionssubstantially.ToeasetheEasterncoalminingindustrywhichfearsaswitchtolow-sulfurWesterncoalthebillrequirestheinstallationofexpensivescrubbersdevicesforremovingsulfurfromthesmokeratherthananorderthatforbidshigh-sulfurfuel.StillthelegislationisbeingvigorouslyopposedbythecoalindustryandutilitiesespeciallyintheMid-westwhereheavyindustriesarebattlingtosurvive.InasurveyalsoreleasedlastweektheEdisonElectricInstituteanindustrygroupgravelypredictedthatelectricityratescouldriseasmuchas50%iftheemission-controllegislationpassed. GovernmentstudiesdisputethesefiguresbutCongresshasbeensuspendedonacid-rainmeasures.Nowasaresultoftheacademystudysupportersofthebillsaremoreoptimistic.Neverthelessamajorpoliticalbattleisshapingup. Thefirstparagraphshowsthat
IsitpossiblethattheideaswehavetodayaboutownershipandpropertyrightshavebeensouniversalinthehumanmindthatitistrulyasiftheyhadsprungfromthemindofGodBynomeans.Theideaofowningandpropertyemergedinthemistsofunrecordedhistory.TheancientJewsforonehadaverydifferentoutlookonpropertyandownershipviewingitassomethingmuchmoretemporaryandtentativethanwedo. TheideaswehaveinAmericaabouttheprivateownershipofproductivepropertyasanaturalanduniversalrightofmankindperhapsofdivineoriginarebynomeansuniversalandmustbeviewedasaninventionofmanratherthanadecreeorderofGod.Ofcoursewearecompletelytrainedtoaccepttheideaofownershipoftheearthanditsproductsrawandtransformed.Itseemsnotatallstrange;infactitisquitedifficulttoimagineasocietywithoutsucharrangements.Ifsomeonesomeindividualdidn’’townthatplotoflandthathousethatfactorythatmachinethattowerofwheathowwouldwefunctionWhatwouldtherulesbeWhomwouldwebuyfromandhowwouldwesell Itisimportanttoacknowledgeasignificantdifferencebetweenachievingownershipsimplybytakingorclaimingpropertyandowningwhatwetendtocallthefruitoflabor.IfIaloneortogetherwithmyfamilyworkonthelandandraisecropsorifImakesomethingusefuloutofnaturalmaterialitseemsreasonableandfairtoclaimthatthecropsortheobjectsbelongtomeormyfamilyaremypropertyatleastinthesensethatIhavefirstclaimonthem.Hardlyanyonewoulddisputethat.Infactsomeoftheearlyradicalworkingmen’’smovementsmadeanownershipclaimonthoseverygrounds.AsindustrialorganizationbecamemorecomplexhoweversuchissuesbecamevastlymoreintricateItmustbeclearthatinmodernsocietythesocialheritageofknowledgeandtechnologyandthesocialorganizationofmanufactureandexchangeaccountforfarmoreoftheproductivityofindustryandthevalueofwhatisproducedthancanbeaccountedforbythelaborofanynumberofindividuals.HardlyanypersoncannowpointandsayThat--thatrightthere--isthefruitofmylabor.Wecansayasasocietyasanation--asaworldreally--thatwhatisproducedisthefruitofourlabortheproductofthewholesocietyasacollectivity. Wehavetorecognizethattherightofprivateindividualownershipofpropertyisman-madeandconstantlydependentontheextenttowhichthosewithoutpropertybelievethattheownercanmakehisclaimstick. Privateownershipofpropertyisfinallydescribedas
Thedifferencesinrelativegrowthofvariousareasofscientificresearchhaveseveralcauses.71.Someofthesecausesarecompletelyreasonableresultsofsocialneeds.Othersarereasonableconsequencesofparticularadvancesinsciencebeingtosomeextentself-accelerating.Somehoweverarelessreasonableprocessesofdifferentgrowthinwhichpreconceptionsoftheformscientifictheoryoughttotakebypersonsinauthorityacttoalterthegrowthpatternofdifferentareas.Thisisanewproblemprobablynotyetunavoidable;butitisafrighteningtrend.72.ThistrendbeganduringtheSecondWorldWarwhenseveralgovernmentscametotheconclusionthatthespecificdemandsthatagovernmentwantstomakeofitsscientificestablishmentcannotgenerallybeforeseenindetail.Itcanbepredictedhoweverthatfromtimetotimequestionswillarisewhichwillrequirespecificscientificanswers.Itisthereforegenerallyvaluabletotreatthescientificestablishmentasaresourceormachinetobekeptinfunctionalorder.73.Thisseemsmostlyeffectivelydonebysupportingacertainamountofresearchnotrelatedtoimmediategoalsbutofpossibleconsequenceinthefuture.Thiskindofsupportlikeallgovernmentsupportrequiresdecisionsabouttheappropriaterecipientsoffunds.Decisionsbasedonutilityasopposedtolackofutilityarestraightforward.Butadecisionamongprojectsnoneofwhichhasimmediateutilityismoredifficult.Thegoalofthesupportingagenciesisthepraisableoneofsupporting"good"asopposedto"bad"sciencebutavaliddeterminationisdifficulttomake.Generallytheideaofgoodsciencetendstobecomeconfusedwiththecapacityofthefieldinquestiontogenerateaneleganttheory.74.Howevertheworldissomadethatelegantsystemsareinprincipleunabletodealwithsomeoftheworld’’smorefascinatinganddelightfulaspects.75.Newformsofthoughtaswellasnewsubjectsforthoughtmustariseinthefutureastheyhaveinthepastgivingrisetonewstandardsofelegance. Thisseemsmostlyeffectivelydonebysupportingacertainamountofresearchnotrelatedtoimmediategoalsbutofpossibleconsequenceinthefuture.
IsitpossiblethattheideaswehavetodayaboutownershipandpropertyrightshavebeensouniversalinthehumanmindthatitistrulyasiftheyhadsprungfromthemindofGodBynomeans.Theideaofowningandpropertyemergedinthemistsofunrecordedhistory.TheancientJewsforonehadaverydifferentoutlookonpropertyandownershipviewingitassomethingmuchmoretemporaryandtentativethanwedo. TheideaswehaveinAmericaabouttheprivateownershipofproductivepropertyasanaturalanduniversalrightofmankindperhapsofdivineoriginarebynomeansuniversalandmustbeviewedasaninventionofmanratherthanadecreeorderofGod.Ofcoursewearecompletelytrainedtoaccepttheideaofownershipoftheearthanditsproductsrawandtransformed.Itseemsnotatallstrange;infactitisquitedifficulttoimagineasocietywithoutsucharrangements.Ifsomeonesomeindividualdidn’’townthatplotoflandthathousethatfactorythatmachinethattowerofwheathowwouldwefunctionWhatwouldtherulesbeWhomwouldwebuyfromandhowwouldwesell Itisimportanttoacknowledgeasignificantdifferencebetweenachievingownershipsimplybytakingorclaimingpropertyandowningwhatwetendtocallthefruitoflabor.IfIaloneortogetherwithmyfamilyworkonthelandandraisecropsorifImakesomethingusefuloutofnaturalmaterialitseemsreasonableandfairtoclaimthatthecropsortheobjectsbelongtomeormyfamilyaremypropertyatleastinthesensethatIhavefirstclaimonthem.Hardlyanyonewoulddisputethat.Infactsomeoftheearlyradicalworkingmen’’smovementsmadeanownershipclaimonthoseverygrounds.AsindustrialorganizationbecamemorecomplexhoweversuchissuesbecamevastlymoreintricateItmustbeclearthatinmodernsocietythesocialheritageofknowledgeandtechnologyandthesocialorganizationofmanufactureandexchangeaccountforfarmoreoftheproductivityofindustryandthevalueofwhatisproducedthancanbeaccountedforbythelaborofanynumberofindividuals.HardlyanypersoncannowpointandsayThat--thatrightthere--isthefruitofmylabor.Wecansayasasocietyasanation--asaworldreally--thatwhatisproducedisthefruitofourlabortheproductofthewholesocietyasacollectivity. Wehavetorecognizethattherightofprivateindividualownershipofpropertyisman-madeandconstantlydependentontheextenttowhichthosewithoutpropertybelievethattheownercanmakehisclaimstick. Accordingtothetexttheconceptofownershipprobably
Thedifferencesinrelativegrowthofvariousareasofscientificresearchhaveseveralcauses.71.Someofthesecausesarecompletelyreasonableresultsofsocialneeds.Othersarereasonableconsequencesofparticularadvancesinsciencebeingtosomeextentself-accelerating.Somehoweverarelessreasonableprocessesofdifferentgrowthinwhichpreconceptionsoftheformscientifictheoryoughttotakebypersonsinauthorityacttoalterthegrowthpatternofdifferentareas.Thisisanewproblemprobablynotyetunavoidable;butitisafrighteningtrend.72.ThistrendbeganduringtheSecondWorldWarwhenseveralgovernmentscametotheconclusionthatthespecificdemandsthatagovernmentwantstomakeofitsscientificestablishmentcannotgenerallybeforeseenindetail.Itcanbepredictedhoweverthatfromtimetotimequestionswillarisewhichwillrequirespecificscientificanswers.Itisthereforegenerallyvaluabletotreatthescientificestablishmentasaresourceormachinetobekeptinfunctionalorder.73.Thisseemsmostlyeffectivelydonebysupportingacertainamountofresearchnotrelatedtoimmediategoalsbutofpossibleconsequenceinthefuture.Thiskindofsupportlikeallgovernmentsupportrequiresdecisionsabouttheappropriaterecipientsoffunds.Decisionsbasedonutilityasopposedtolackofutilityarestraightforward.Butadecisionamongprojectsnoneofwhichhasimmediateutilityismoredifficult.Thegoalofthesupportingagenciesisthepraisableoneofsupporting"good"asopposedto"bad"sciencebutavaliddeterminationisdifficulttomake.Generallytheideaofgoodsciencetendstobecomeconfusedwiththecapacityofthefieldinquestiontogenerateaneleganttheory.74.Howevertheworldissomadethatelegantsystemsareinprincipleunabletodealwithsomeoftheworld’’smorefascinatinganddelightfulaspects.75.Newformsofthoughtaswellasnewsubjectsforthoughtmustariseinthefutureastheyhaveinthepastgivingrisetonewstandardsofelegance. ThistrendbeganduringtheSecondWorldWarwhenseveralgovernmentscametotheconclusionthatthespecificdemandsthatagovernmentwantstomakeofitsscientificestablishmentcannotgenerallybeforeseenindetail.
Whatoursocietysuffersfrommosttodayistheabsenceofconsensusaboutwhatitandlifeinitoughttobe.Suchconsensuscannotbegainedfromsociety’’spresentstageorfromfantasiesaboutwhatitoughttobe.Forthatthepresentistoocloseandtoodiversifiedandthefuturetoouncertaintomakebelievableclaimsaboutit.AconsensusinthepresenthencecanbeachievedonlythroughasharedunderstandingofthepastasHomer’’sepics史诗informedthosewholivedcenturieslaterwhatitmeanttobeGreekandbywhatimagesandidealstheyweretolivetheirlivesandorganizetheirsocieties. Mostsocietiesderiveconsensusfromalonghistoryalanguagealltheirownacommonreligioncommonancestry.Themythsbywhichtheylivearebasedonallofthese.ButtheUnitedStatesisacountryofimmigrantscomingfromagreatvarietyofnations.Latelyithasbeenemphasizedthatanasocialnarcissistic自我陶醉的personalityhasbecomecharacteristicofAmericansandthatitisthistypeofpersonalitythatmakesforthelackofwell-beingbecauseitpreventsusfromachievingconsensusthatwouldcounteractatendencytowithdrawintoprivateworlds.InhisstudyofnarcissismChristopherLaschsaysthatmodernmantorturedbyself-consciousnessturnstonewtherapiesnottofreehimselfofhispersonalworriesbuttofindmeaningandpurposeinlifetofindsomethingtolivefor.Thereiswidespreaddistressbecausenationalmoralehasdeclinedandwehavelostanearliersenseofnationalvisionandpurpose. Contrarytorigidreligionsorpoliticalbeliefsasarefoundintotalitarian极权主义的societiesourcultureisoneofgreatindividualdifferencesatleastinprincipleandintheory.Butthisleadstodisunityevenchaos.Americansbelieveinthevalueofdiversitybutjustbecauseoursisasocietybasedonindividualdiversityitneedsconsensusaboutsomedominatingideasmorethansocietiesbasedonuniformoriginoftheircitizens.Henceifwearetohaveconsensusitmustbebasedonamyth―avision―aboutacommonexperienceaconquestthatmadeusAmericansasthemythabouttheconquestofTroyformedtheGreeks.Onlyacommonmythcanofferrelieffromthefearthatlifeiswithoutmeaningorpurpose.Mythspermitustoexamineourplaceintheworldbycomparingittoasharedidea.Mythsaresharedfantasiesthatformthetiethatbindstheindividualtoothermembersofhisgroup.Suchmythshelptowardofffeelingsofisolationguiltanxietyandpurposelessness―inshorttheycombatisolationandthebreakdownofsocialstandardsandvalues. Homer’’sepicsmentionedinParagraph1exemplifiesthefactthat
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InspiteofrisingconcernintheNortheastandCanadaAdministrationspokesmenhaverepeatedlyinsistedthatnothingcouldreallybedoneaboutacidrainandtheindustry-producedsulfuremissionsuntilallthescientificfactswerein.Suddenlylastweekhoweverfactscamerainingdownineffectmakingfurtherscientificdebateonwhatmainlycausestheproblemallbutirrelevant. WhatbroughtaboutthedownpourwasastudycommissionedbyPresidentialScienceAdviser.Thespokesmenplainlycalledforremedialactionevenifsometechnicalquestionsaboutacidrainwerestillunanswered.Ifwetaketheconservativepointofviewthatwemustwaituntilthescientificknowledgeisdefinitivesaidthespokesmantheaccumulateddepositionanddamagedenvironmentmayreachthepointof’’irreversibility’’. Whenitrainsitpours.NextcameastudyfromtheNationalResearchCouncil.Itsdefinitiveconclusion:reducingemissionsofsulfurdioxidefromcoal-burningpowerplantsandfactoriessuchastheseintheMidwestwouldinfactsignificantlyreducetheacidityinrainsnowandotherprecipitation降水thatiswidelybelievedtobeworseningthelifefromfresh-waterlakesandforestsintheNortheastandCanada.Thespokesmandidnotrecommendanyspecificaction. ApairofremedialmeasuresarealreadytakenbeforeCongress.ASenatecommitteerecentlyapprovedabillthatwouldrequirereductionoverthenextdecadeofsulfur-dioxideemissionsby10milliontonsintheStatesborderingontheeastoftheMississippi.AtoughermeasurewasintroducedintheHouseorderingthe50largestsulfurpollutersintheU.S.tocutemissionssubstantially.ToeasetheEasterncoalminingindustrywhichfearsaswitchtolow-sulfurWesterncoalthebillrequirestheinstallationofexpensivescrubbersdevicesforremovingsulfurfromthesmokeratherthananorderthatforbidshigh-sulfurfuel.StillthelegislationisbeingvigorouslyopposedbythecoalindustryandutilitiesespeciallyintheMid-westwhereheavyindustriesarebattlingtosurvive.InasurveyalsoreleasedlastweektheEdisonElectricInstituteanindustrygroupgravelypredictedthatelectricityratescouldriseasmuchas50%iftheemission-controllegislationpassed. GovernmentstudiesdisputethesefiguresbutCongresshasbeensuspendedonacid-rainmeasures.Nowasaresultoftheacademystudysupportersofthebillsaremoreoptimistic.Neverthelessamajorpoliticalbattleisshapingup. Thisarticlemostprobablyappearedin
Whatoursocietysuffersfrommosttodayistheabsenceofconsensusaboutwhatitandlifeinitoughttobe.Suchconsensuscannotbegainedfromsociety’’spresentstageorfromfantasiesaboutwhatitoughttobe.Forthatthepresentistoocloseandtoodiversifiedandthefuturetoouncertaintomakebelievableclaimsaboutit.AconsensusinthepresenthencecanbeachievedonlythroughasharedunderstandingofthepastasHomer’’sepics史诗informedthosewholivedcenturieslaterwhatitmeanttobeGreekandbywhatimagesandidealstheyweretolivetheirlivesandorganizetheirsocieties. Mostsocietiesderiveconsensusfromalonghistoryalanguagealltheirownacommonreligioncommonancestry.Themythsbywhichtheylivearebasedonallofthese.ButtheUnitedStatesisacountryofimmigrantscomingfromagreatvarietyofnations.Latelyithasbeenemphasizedthatanasocialnarcissistic自我陶醉的personalityhasbecomecharacteristicofAmericansandthatitisthistypeofpersonalitythatmakesforthelackofwell-beingbecauseitpreventsusfromachievingconsensusthatwouldcounteractatendencytowithdrawintoprivateworlds.InhisstudyofnarcissismChristopherLaschsaysthatmodernmantorturedbyself-consciousnessturnstonewtherapiesnottofreehimselfofhispersonalworriesbuttofindmeaningandpurposeinlifetofindsomethingtolivefor.Thereiswidespreaddistressbecausenationalmoralehasdeclinedandwehavelostanearliersenseofnationalvisionandpurpose. Contrarytorigidreligionsorpoliticalbeliefsasarefoundintotalitarian极权主义的societiesourcultureisoneofgreatindividualdifferencesatleastinprincipleandintheory.Butthisleadstodisunityevenchaos.Americansbelieveinthevalueofdiversitybutjustbecauseoursisasocietybasedonindividualdiversityitneedsconsensusaboutsomedominatingideasmorethansocietiesbasedonuniformoriginoftheircitizens.Henceifwearetohaveconsensusitmustbebasedonamyth―avision―aboutacommonexperienceaconquestthatmadeusAmericansasthemythabouttheconquestofTroyformedtheGreeks.Onlyacommonmythcanofferrelieffromthefearthatlifeiswithoutmeaningorpurpose.Mythspermitustoexamineourplaceintheworldbycomparingittoasharedidea.Mythsaresharedfantasiesthatformthetiethatbindstheindividualtoothermembersofhisgroup.Suchmythshelptowardofffeelingsofisolationguiltanxietyandpurposelessness―inshorttheycombatisolationandthebreakdownofsocialstandardsandvalues. TheasocialpersonalityofAmericansresultsfrom
InspiteofrisingconcernintheNortheastandCanadaAdministrationspokesmenhaverepeatedlyinsistedthatnothingcouldreallybedoneaboutacidrainandtheindustry-producedsulfuremissionsuntilallthescientificfactswerein.Suddenlylastweekhoweverfactscamerainingdownineffectmakingfurtherscientificdebateonwhatmainlycausestheproblemallbutirrelevant. WhatbroughtaboutthedownpourwasastudycommissionedbyPresidentialScienceAdviser.Thespokesmenplainlycalledforremedialactionevenifsometechnicalquestionsaboutacidrainwerestillunanswered.Ifwetaketheconservativepointofviewthatwemustwaituntilthescientificknowledgeisdefinitivesaidthespokesmantheaccumulateddepositionanddamagedenvironmentmayreachthepointof’’irreversibility’’. Whenitrainsitpours.NextcameastudyfromtheNationalResearchCouncil.Itsdefinitiveconclusion:reducingemissionsofsulfurdioxidefromcoal-burningpowerplantsandfactoriessuchastheseintheMidwestwouldinfactsignificantlyreducetheacidityinrainsnowandotherprecipitation降水thatiswidelybelievedtobeworseningthelifefromfresh-waterlakesandforestsintheNortheastandCanada.Thespokesmandidnotrecommendanyspecificaction. ApairofremedialmeasuresarealreadytakenbeforeCongress.ASenatecommitteerecentlyapprovedabillthatwouldrequirereductionoverthenextdecadeofsulfur-dioxideemissionsby10milliontonsintheStatesborderingontheeastoftheMississippi.AtoughermeasurewasintroducedintheHouseorderingthe50largestsulfurpollutersintheU.S.tocutemissionssubstantially.ToeasetheEasterncoalminingindustrywhichfearsaswitchtolow-sulfurWesterncoalthebillrequirestheinstallationofexpensivescrubbersdevicesforremovingsulfurfromthesmokeratherthananorderthatforbidshigh-sulfurfuel.StillthelegislationisbeingvigorouslyopposedbythecoalindustryandutilitiesespeciallyintheMid-westwhereheavyindustriesarebattlingtosurvive.InasurveyalsoreleasedlastweektheEdisonElectricInstituteanindustrygroupgravelypredictedthatelectricityratescouldriseasmuchas50%iftheemission-controllegislationpassed. GovernmentstudiesdisputethesefiguresbutCongresshasbeensuspendedonacid-rainmeasures.Nowasaresultoftheacademystudysupportersofthebillsaremoreoptimistic.Neverthelessamajorpoliticalbattleisshapingup. FromthedescriptionoftheeffortsintheHousewecanseethat
IsitpossiblethattheideaswehavetodayaboutownershipandpropertyrightshavebeensouniversalinthehumanmindthatitistrulyasiftheyhadsprungfromthemindofGodBynomeans.Theideaofowningandpropertyemergedinthemistsofunrecordedhistory.TheancientJewsforonehadaverydifferentoutlookonpropertyandownershipviewingitassomethingmuchmoretemporaryandtentativethanwedo. TheideaswehaveinAmericaabouttheprivateownershipofproductivepropertyasanaturalanduniversalrightofmankindperhapsofdivineoriginarebynomeansuniversalandmustbeviewedasaninventionofmanratherthanadecreeorderofGod.Ofcoursewearecompletelytrainedtoaccepttheideaofownershipoftheearthanditsproductsrawandtransformed.Itseemsnotatallstrange;infactitisquitedifficulttoimagineasocietywithoutsucharrangements.Ifsomeonesomeindividualdidn’’townthatplotoflandthathousethatfactorythatmachinethattowerofwheathowwouldwefunctionWhatwouldtherulesbeWhomwouldwebuyfromandhowwouldwesell Itisimportanttoacknowledgeasignificantdifferencebetweenachievingownershipsimplybytakingorclaimingpropertyandowningwhatwetendtocallthefruitoflabor.IfIaloneortogetherwithmyfamilyworkonthelandandraisecropsorifImakesomethingusefuloutofnaturalmaterialitseemsreasonableandfairtoclaimthatthecropsortheobjectsbelongtomeormyfamilyaremypropertyatleastinthesensethatIhavefirstclaimonthem.Hardlyanyonewoulddisputethat.Infactsomeoftheearlyradicalworkingmen’’smovementsmadeanownershipclaimonthoseverygrounds.AsindustrialorganizationbecamemorecomplexhoweversuchissuesbecamevastlymoreintricateItmustbeclearthatinmodernsocietythesocialheritageofknowledgeandtechnologyandthesocialorganizationofmanufactureandexchangeaccountforfarmoreoftheproductivityofindustryandthevalueofwhatisproducedthancanbeaccountedforbythelaborofanynumberofindividuals.HardlyanypersoncannowpointandsayThat--thatrightthere--isthefruitofmylabor.Wecansayasasocietyasanation--asaworldreally--thatwhatisproducedisthefruitofourlabortheproductofthewholesocietyasacollectivity. Wehavetorecognizethattherightofprivateindividualownershipofpropertyisman-madeandconstantlydependentontheextenttowhichthosewithoutpropertybelievethattheownercanmakehisclaimstick. Onedeservestoclaimonsomeproductonlywhen
TheSupremeCourt’’sdecisionsonphysician-assistedsuicidecarryimportantimplicationsforhowmedicineseekstorelievedyingpatientsofpainandsuffering. Althoughitruledthatthereisnoconstitutionalrighttophysician-assistedsuicidetheCourtineffectsupportedthemedicalprincipleofdoubleeffectacenturies-oldmoralprincipleholdingthatanactionhavingtwoeffects―agoodonethatisintendedandaharmfulonethatisforeseen―ispermissibleiftheactorintendsonlythegoodeffect. Doctorshaveusedthatprincipleinrecentyearstojustifyusinghighdosesofmorphinetocontrolterminallyiiipatients’’paineventhoughincreasingdosageswilleventuallykillthepatient. NancyDublerdirectorofMontefioreMedicalCentercontendsthattheprinciplewillshielddoctorswhountilnowhaveveryverystronglyinsistedthattheycouldnotgivepatientssufficientmedicationtocontroltheirpainifthatmighthastendeath. GeorgeAnnaschairofthehealthlawdepartmentatBostonUniversitymaintainsthataslongasadoctorprescribesadrugforalegitimatemedicalpurposethedoctorhasdonenothingillegalevenifthepatientusesthedrugtohastendeath.It’’slikesurgeryhesays.Wedon’’tcallthosedeathshomicidesbecausethedoctorsdidn’’tintendtokilltheirpatientsalthoughtheyriskedtheirdeath.Ifyou’’reaphysicianyoucanriskyourpatients’’suicideaslongasyoudon’’tintendtheirsuicide. Onanotherlevelmanyinthemedicalcommunityacknowledgethattheassisted-suicidedebatehasbeenfueledinpartbythedespairofpatientsforwhommodernmedicinehasprolongedthephysicalagonyofdying. JustthreeweeksbeforetheCourt’’srulingonphysician-assistedsuicidetheNationalAcademyofScienceNASreleasedatwo-volumereportApproachingDeath:ImprovingCareattheEndofLife.Itidentifiestheundertreatmentofpainandtheaggressiveuseofineffectualandforcedmedicalproceduresthatmayprolongandevendishonortheperiodofdyingasthetwinproblemsofend-of-lifecare. TheprofessionistakingstepstorequireyoungdoctorstotraininhospicestotestknowledgeofaggressivepainmanagementtherapiestodevelopaMedicarebillingcodeforhospital-basedcareandtodevelopnewstandardsforassessingandtreatingpainattheendoflife. Annassayslawyerscanplayakeyroleininsistingthatthesewell-meaningmedicalinitiativestranslateintobettercare.Largenumbersofphysiciansseemunconcernedwiththepaintheirpatientsareneedlesslyandpredictablysufferingtotheextentthatitconstitutessystematicpatientabuse.Hesaysmedicallicensingboardsmustmakeitclear..thatpainfuldeathsarepresumptivelyonesthatareincompetentlymanagedandshouldresultinlicensesuspension. Whichofthefollowingstatementsistrueaccordingtothetext
TheSupremeCourt’’sdecisionsonphysician-assistedsuicidecarryimportantimplicationsforhowmedicineseekstorelievedyingpatientsofpainandsuffering. Althoughitruledthatthereisnoconstitutionalrighttophysician-assistedsuicidetheCourtineffectsupportedthemedicalprincipleofdoubleeffectacenturies-oldmoralprincipleholdingthatanactionhavingtwoeffects―agoodonethatisintendedandaharmfulonethatisforeseen―ispermissibleiftheactorintendsonlythegoodeffect. Doctorshaveusedthatprincipleinrecentyearstojustifyusinghighdosesofmorphinetocontrolterminallyiiipatients’’paineventhoughincreasingdosageswilleventuallykillthepatient. NancyDublerdirectorofMontefioreMedicalCentercontendsthattheprinciplewillshielddoctorswhountilnowhaveveryverystronglyinsistedthattheycouldnotgivepatientssufficientmedicationtocontroltheirpainifthatmighthastendeath. GeorgeAnnaschairofthehealthlawdepartmentatBostonUniversitymaintainsthataslongasadoctorprescribesadrugforalegitimatemedicalpurposethedoctorhasdonenothingillegalevenifthepatientusesthedrugtohastendeath.It’’slikesurgeryhesays.Wedon’’tcallthosedeathshomicidesbecausethedoctorsdidn’’tintendtokilltheirpatientsalthoughtheyriskedtheirdeath.Ifyou’’reaphysicianyoucanriskyourpatients’’suicideaslongasyoudon’’tintendtheirsuicide. Onanotherlevelmanyinthemedicalcommunityacknowledgethattheassisted-suicidedebatehasbeenfueledinpartbythedespairofpatientsforwhommodernmedicinehasprolongedthephysicalagonyofdying. JustthreeweeksbeforetheCourt’’srulingonphysician-assistedsuicidetheNationalAcademyofScienceNASreleasedatwo-volumereportApproachingDeath:ImprovingCareattheEndofLife.Itidentifiestheundertreatmentofpainandtheaggressiveuseofineffectualandforcedmedicalproceduresthatmayprolongandevendishonortheperiodofdyingasthetwinproblemsofend-of-lifecare. TheprofessionistakingstepstorequireyoungdoctorstotraininhospicestotestknowledgeofaggressivepainmanagementtherapiestodevelopaMedicarebillingcodeforhospital-basedcareandtodevelopnewstandardsforassessingandtreatingpainattheendoflife. Annassayslawyerscanplayakeyroleininsistingthatthesewell-meaningmedicalinitiativestranslateintobettercare.Largenumbersofphysiciansseemunconcernedwiththepaintheirpatientsareneedlesslyandpredictablysufferingtotheextentthatitconstitutessystematicpatientabuse.Hesaysmedicallicensingboardsmustmakeitclear..thatpainfuldeathsarepresumptivelyonesthatareincompetentlymanagedandshouldresultinlicensesuspension. Whichofthefollowingbestdefinesthewordaggressiveline3paragraph7
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