MEDICAL STUDENTS CENTRE, Vol. VI No. 9 OFFICIAL...
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MEDICAL STUDENTS’ CENTRE, SASSOON ROAD, HONGKONG. Present Circulation Vol.VI No.9 OFFICIAL PUBLICATION OF THE MEDICAL SOCIETY, H.K.U.S.U. 4000copies Sept. 1974 Should the Patient he ALLOWED TO DIE???;0] Inthecycle ofhuman life, one isaware thatsooner or later, onehastodiebuttheproblem ofdeathas now reached a newdimension due tothegreat advances inmedical science. Must doctors always extend lifewhen they aretechnically able todoso, heedless ofthequality of existance they arepreserving? Better medical care andeducation have effected alow morbidity andmortality among the people. Thenumber of oldpeople isontherise, andasa result, there isan increasing number of people withmalignancies andchronic disease associated particularly witholdageandcancer. These arethepatients whowould most likely request that thedoctor should allow them todiebefore thedisease takes itsnatural course. Should doctors comply withsuch a request? ‘Allowing thepatient todie”seems atfirst sight to imply just the“permitting” ofdeath by omission. Where suchdecision iscome toatthedoctor’s solediscretion without thepatients’ consent, onthegrounds of the hopelessness ofthepatients’ case orthedegeneration of mental state, weareinvolved in involuntary euthanasia. Howcver, allowing thepatient todie”may betaken to mean thatthedoctor, at tnepatients’ request to be allowed todieincomfort anddignity, actspositively to terminate life,forexample, byinjecting adrugwhich killsboth the patient andthe pain. hisisvoluntary euthanasia. Iherefore, in thefollowing discussion, we shail corisder theissues involved inboth voluntary and rnvoiuiitary euthanasia aomirristered to patients whohave nochance inrecovering. it would beuseful toinvestigate theproblem with regaro toitsmedical, iegal, reiigrous, ethical, social and economic aspects Decause these aretheconsiderations which willguide doctors intneir decisions between life anddeath. THLMEDICAL ASPECT Theprime function ofmedicine istopromote human health, hence, doctors oreconcerned intimately with the postponement ofhuman oeatn. Doctors arereluctant to violate theHippocratic Datnwhich obliges them todo allthey cantopreserve Ite. However, it isnotclear what a doctor should dowhen thefirst part oftheoath “tohelp thesickaccording tohisacuity and judgment” conflicts withthesecoiu part, ‘nottogiveanyone a lethal dose even if ascotoaoso. . “ Ihe helping of thesick invoives tIre ending of pain andsuffering and theremay becases when pain cannot beended without ending lireitself.Furtncmmore, thereduction of pain often requires sedation, sometimes tothepoint thathe patient leads analmua1 vegetative, albeit comfortable, existence, when theuserunc’ss 01thebody iscompletely gone. It isdebateabie wnether bykeeping theoath in suchacase, doctors areactually preserving lifeor prolonging theactof dying. The International Code ofMedical Ethics states that a doctor must always bear inmind theimportance of Jreserving life‘until death’. Thishows theimportance ofthedetini’ron ofdeath. Atwhat point intime isthe patient considered dead, sothatthedoctor should abandon allmethods ofsaving his life?Theconventional criteria is theirreversible cessation of heartbeat and respiration. However, other authorities propose thatthe cessation of brainwave activity measurable onanelectroencephalograph electroencephalograph (LEG) isamore reliable index ofdeath. Yetbrainwave activity canresume after sonic period of time.Just recently, iiiRussia, a patient “woke up”after 21years ofunconsciousness. It is important that insuch a case, atleast, doctors should riot allow patients todie. Some doctors object tothe idea ofeuthanasia because theysay itwillundermine therelationship ofconfidence between doctors andpatients. The knowledge thathe doctor willight forhislifeisof great importance tothe patient inhelping him to playhispart in following the doctor’s instructions and strengthening hiswilltorecover. Although euthanasia would only beadministered topatient whohadnochance torecover, it isfeared thatheidea of euthanasia willaffect allclasses ofpatients. When a doctor enters theroom, thepatient willnotbesure whether hehascome tokillortocure. Clearly aneffort must bemade, wereuthanasia tobe implemented, to disassociate in thepatient’s mind thedoctor andthe destroyer. Thiscannever be complete, however, granted thatthedoctor must advise whether the patient isa suitable candidate forthisextreme cure. THELEGAL ASPECT Another reason why doctors arereluctant toallow their patients todieisthatheycanbeprosecuted under the present law.Since theSuicide Act1961, it isnotillegal to attempt or commit suicide butdoctors whoassist persons totake their lives areheld responsible asaiders andabetters totheactofself-murder. Inanalysing adoctor’s legal duty tohispatients, one must first corisder whether thequestion involves anact oranomission. Adoctor whoperforms a deliberate act resulting indeath is guilty ofmurder. If hecauses the patient’s death bynegligent conduct butwithout theintention intention tokill,heisliable for manslaughter. However, ifhemerely “omits” todosomething tokeeph:spatient alive, hemayonly beliable for negligence ifheisunder a duty to act. Sometimes, a physical “act”suchas swtcning offtherespirator, canbean“omission” inlaw if it merely yuts intoeffect a decision totakenofurther steps. Letusnowconsider thesecond element ofmurder, namely, intention andmalice aforethought. Theaimof theaoctor isnottokill,buttorelieve pain, yetif he knows forcertaii, tnatac’ath istofollow asa result of his administering a pan-kiiiing drug, that knowledge is enough toestabiish intention in law. Applying thenatural meaning oftheword” malice”, onecannot say that a uoctor wriekillsa patient tosave himfrompaindoesowthrnaiice aforethought. It is actually compassion that urges urntokinbutmalice in thelegal sense dots riot involve illwinoicase motive, it is impired frorir tilecourse ofconduct, Therefore, it istruetosaythatunless thelawis changed, doctors are exposed totnedanger ofbeing prosecuted. Different ways of arnerd:ng thepresent lawhave been putforward. 1iiePnriidrnei,t bill19a6 requires the patient to sign a turmai applicator; foreutnanasia. However, the eiaboiate sareguaros tOut accompanied that appiication were cr,tic,sed as bringing mo rn,inry formalities intotne sick room. It isdisC asserted tnat wflun a patient isso distressed byhisteirliridi illness astowant death, he is in no mental condition to havehis request for euthanasia taken seriousiy aid conversely, when a patient issowe’ll-adjusted toitstnati.srequest todiewould berespected. heis uiiirkely tcask fordeath. It isCisC argued thathep0tieiit cannever givea trulyntornie’J sown hiry conseri t toat. btnier heisrot yetsuffering pain, ii wn,cn casehisconserir is rriereiy diiuciintormcd arid witicipalory one, orheiscrazed by pain niwhich case lieisriotofsound mind.Furthermore, Furthermore, theconsent ri;abe negated byundue influence both from tntrelative’s andthedoctors Since (hrpticritnearing death may nothave the mental condition toconsent to die, the Parliamentary Bill 1’J69 suggested that hicmay make adeclaration inadvance stating tnat hewshe5 incc rtairi circumstances tob put painlessly lo death. Theproblem inthiscase5 tht manitenance ofthatwishuptothe veryastmoment. THERELIGIOUS ASPECT TheRoman Catholic Church, inPopePiusXll’s Encyclical, Mystic Corponis, hasmade clear itsrejection of any formofeuthanasia. The Archb:shop ofCanterbury, speaking intheHouse ofLords debate 1936 echoed th. same view. Therearethreereasons whyChristians conidern: euthanasia. First, they regard Lime as helenging toGod Manonlyholds it iiitiList. IIc has theiiL’of t but hemaynot destroy it atwill. Secomidlf. Christians think thatnomanhas theright totakeaninnocent life. “The innocent and th just, the,: shalt notkill” says Exodos (23:7) Thirdly, stiffening fortheChristian is etanabsoRd’’ evil,It maybeanoccasion for spiritual rowthandan opportunity to make amends forsin.Christians shoed offeruptheir suffering in union withthePassion o Christ. Although Christians officially condemn’ euthanasia, one can actually justify euthanasia onChristian principles. Theroot ofallChristian morality us“Love Godand Thy neighbour”. Love would urgeustopermit oursuffering neighbour tochoose an easy death and toobtain medical aidin implementing thatchoice. Printed byShum Shing Printing Compan. Hoop, Kcrrg TheScripture tellsus Blessed arethemerciful.” If weshowmercy toourdogs andcats byputting them to ‘sleep” (when wecannot reduce theirsufferings), why should webelessmerciful tomen especially when men canexpress their wish todieandexpect thedoctor to help? Some maysay that itisGods will that weshould use thereason, conscience andfreedom ofchoice which He hasgiven ustofight against theevil ofa painful death andseeka remedy fromadoctor. Alternatively, other Christians may present thecomplete reverse with thesame argument. THEETHICAL ASPECT The first ethical argument infavour ofeuthanasia is that itiscruel toallow numan beings tolinger formonth inthelaststages oftheir lives in agony, weakness and decay and torefuse them their demands fordeath. It is alsocruel toforce therelatives tosee their loved ones inthedesperate plight inthe long-drawn-out process of dying. Thesecond argument isthatofLiberty. The liberty involved isthatofthepatient aswell asthedoctor. A patient should have theright tochoose adeath of dignity and repose. Onthedoctors part, if he honestly believe thatthebest service hecanperform forhissufferin patient istoaccede tohisrequest foreuthanasia he should notbeforbidden torioso. Thethird argument isthathevalue oflifeisits quality andnotits quantity. Severe paindemorali personality and destroys personal integrity, andthus negates the quality oflife. Quality isalsomeasured by thevalue ofanindividual’s lifetothecommunity. Howover, theconcept ofthequality oflife” isvague By what possible standard can anybody assess thelevel of quality belowhich lifeisworthless? It isimpossi fordeath toimprove thequality oflife.Theonly possib way inwhich thedeath ofanindividual canbesaid to enhance thequality oflife, is statistically: theeliminati ofthelower quality lives would leave thesurvivors show showing a higher average quality oflife.Buthisprinciple is inhuman andshows norespect fortheindividual. Letusnowconsider theethical arguments agains euthanasia. First, there is theriskof anincorre diagnosis. Wecannot expect togive theaverage docto theresponsibility for ending a patient’s life.This decisio isfallible and theconsequence ofthemistake isirrepa irreparable. Doctors canbecareless andunstable at times theymight bemisguided by a pity thatoverwhe judgmnt. It istruethathepossibility ofa mistake does not deter society frompursuing a particular lineofcondu -— if thelineofconduct iscompelled by needwhich overridos theriskofthemistake. Theneed foreuthana torelieve pammust be very great before onecan tolerat thepossibilty ofa fatal mistake. Moreover, there istheriskofadministering euthana toa patient whocould later have been cured bydevelo developrnents inMedical Knowledge. While there islifethere is hope. Theargument against this isthatnewdiscove requve a long timebefore they canbeapplied genera (Continued on Page2)
Transcript of MEDICAL STUDENTS CENTRE, Vol. VI No. 9 OFFICIAL...
MEDICALSTUDENTS’CENTRE,SASSOONROAD,
HONGKONG.
PresentCirculationVol.VI No.9 OFFICIAL PUBLICATION OF THE MEDICAL SOCIETY, H.K.U.S.U. 4000copies Sept.1974;1]
Should the Patient he ALLOWED TO DIE???;0]
Inthecycleofhumanlife,oneisawarethatsooneror later,onehastodiebuttheproblemofdeathhasnowreacheda newdimensionduetothegreatadvancesinmedicalscience.Mustdoctorsalwaysextendlifewhentheyaretechnicallyabletodoso,heedlessofthequalityofexistancetheyarepreserving?
Bettermedicalcareandeducationhaveeffectedalowmorbidityandmortalityamongthepeople.Thenumberofoldpeopleisontherise,andasa result,thereisanincreasingnumberofpeoplewithmalignanciesandchronicdiseaseassociatedparticularlywitholdageandcancer.Thesearethepatientswhowouldmostlikelyrequestthatthedoctorshouldallowthemtodiebeforethediseasetakesitsnaturalcourse.Shoulddoctorscomplywithsucha request?
‘Allowingthepatienttodie”seemsatfirstsighttoimplyjustthe“permitting”ofdeathbyomission.Wheresuchdecisioniscometoatthedoctor’ssolediscretionwithoutthepatients’consent,onthegroundsof thehopelessnessofthepatients’caseorthedegenerationofmentalstate,weareinvolvedininvoluntaryeuthanasia.Howcver,allowingthepatienttodie”maybetakentomeanthatthedoctor,at tnepatients’requesttobeallowedtodieincomfortanddignity,actspositivelytoterminatelife,forexample,byinjectinga drugwhichkillsboththepatientandthepain. hisisvoluntaryeuthanasia.Iherefore,in thefollowingdiscussion,weshailcorisdertheissuesinvolvedinbothvoluntaryandrnvoiuiitaryeuthanasiaaomirristeredtopatientswhohavenochanceinrecovering.
it wouldbeusefultoinvestigatetheproblemwithregarotoitsmedical,iegal,reiigrous,ethical,socialandeconomicaspectsDecausethesearetheconsiderationswhichwillguidedoctorsintneirdecisionsbetweenlifeanddeath.THLMEDICALASPECT
Theprimefunctionofmedicineistopromotehumanhealth,hence,doctorsoreconcernedintimatelywiththepostponementofhumanoeatn.DoctorsarereluctanttoviolatetheHippocraticDatnwhichobligesthemtodoalltheycantopreserveIte. However,it isnotclearwhata doctorshoulddowhenthefirstpartoftheoath“tohelpthesickaccordingtohisacuityandjudgment”conflictswiththesecoiupart,‘nottogiveanyonealethaldoseevenifascotoaoso. .“IhehelpingofthesickinvoivestIreendingofpainandsufferingandtheremaybecaseswhenpaincannotbeendedwithoutendinglireitself.Furtncmmore,thereductionof painoftenrequiressedation,sometimestothepointthatthepatientleadsanalmua1vegetative,albeitcomfortable,existence,whentheuserunc’ss01thebodyiscompletelygone.It isdebateabiewnetherbykeepingtheoathinsucha case,doctorsareactuallypreservinglifeorprolongingtheactofdying.
TheInternationalCodeofMedicalEthicsstatesthata doctormustalwaysbearinmindtheimportanceofJreservinglife‘untildeath’.Thisshowstheimportanceofthedetini’ronofdeath.Atwhatpointintimeisthepatientconsidereddead,sothatthedoctorshouldabandonallmethodsofsavinghislife?Theconventionalcriteriais theirreversiblecessationof heartbeatandrespiration.However,otherauthoritiesproposethatthecessationofbrainwaveactivitymeasurableonanelectroencephalographelectroencephalograph(LEG)isamorereliableindexofdeath.Yetbrainwaveactivitycanresumeaftersonicperiodoftime.Justrecently,iiiRussia,apatient“wokeup”after21yearsofunconsciousness.It isimportantthatinsucha case,atleast,doctorsshouldriotallowpatientstodie.
Somedoctorsobjecttotheideaofeuthanasiabecausetheysayit willunderminetherelationshipofconfidencebetweendoctorsandpatients.Theknowledgethatthedoctorwilllightforhislifeisofgreatimportancetothepatientinhelpinghimtoplayhispartinfollowingthedoctor’sinstructionsandstrengtheninghiswilltorecover.Althougheuthanasiawouldonlybeadministeredtopatientwhohadnochancetorecover,it isfearedthattheideaofeuthanasiawillaffectallclassesofpatients.Whena doctorenterstheroom,thepatientwillnotbesurewhetherhehascometokillortocure.Clearlyaneffortmustbemade,wereeuthanasiatobeimplemented,todisassociatein thepatient’smindthedoctorandthedestroyer.Thiscanneverbecomplete,however,grantedthatthedoctormustadvisewhetherthepatientisasuitablecandidateforthisextremecure.
THELEGALASPECTAnotherreasonwhydoctorsarereluctanttoallowtheir
patientstodieisthattheycanbeprosecutedunderthepresentlaw.SincetheSuicideAct1961,it isnotillegalto attemptorcommitsuicidebutdoctorswhoassistpersonstotaketheirlivesareheldresponsibleasaidersandabetterstotheactofself-murder.
Inanalysingadoctor’slegaldutytohispatients,onemustfirstcorisderwhetherthequestioninvolvesanactoranomission.Adoctorwhoperformsa deliberateactresultingindeathisguiltyofmurder.If hecausesthepatient’sdeathbynegligentconductbutwithouttheintentionintentiontokill,heisliableformanslaughter.However,if hemerely“omits”todosomethingtokeeph:spatientalive,hemayonlybeliablefornegligenceif heisundera dutytoact. Sometimes,a physical“act”suchasswtcningofftherespirator,canbean“omission”inlawif it merelyyutsintoeffectadecisiontotakenofurthersteps.
Letusnowconsiderthesecondelementofmurder,namely,intentionandmaliceaforethought.Theaimoftheaoctorisnottokill,buttorelievepain,yetif heknowsforcertaii,tnatac’athistofollowasa resultofhisadministeringa pan-kiiiingdrug,thatknowledgeisenoughtoestabiishintentioninlaw.
Applyingthenaturalmeaningoftheword”malice”,onecannotsaythatauoctorwriekillsa patienttosavehimfrompaindoesowthrnaiiceaforethought.It isactuallycompassionthaturgesurntokinbutmaliceinthelegalsensedotsriotinvolveillwinoicasemotive,it isimpiredfrorirtilecourseofconduct,Therefore,itistruetosaythatunlessthelawischanged,doctorsareexposedtotnedangerofbeingprosecuted.
Differentwaysofarnerd:ngthepresentlawhavebeenputforward.1iiePnriidrnei,tbill19a6requiresthepatienttosignaturmaiapplicator;foreutnanasia.However,theeiaboiatesareguarostOutaccompaniedthatappiicationwerecr,tic,sedasbringingmorn,inryformalitiesintotnesickroom.It isdisCassertedtnatwfluna patientissodistressedbyhisteirliridiillnessastowantdeath,heis in nomentalconditionto havehisrequestforeuthanasiatakenseriousiyaidconversely,whenapatientissowe’ll-adjustedto itstnatti.srequesttodiewouldberespected.heisuiiirkelytcaskfordeath.
It isCisCarguedthatthep0tieiitcannevergiveatrulyntornie’Jsownhiryconserit toat. btnierheisrotyetsufferingpain,ii wn,cncasehisconseririsrriereiydiiuciintormcdaridwiticipaloryone,orheiscrazedbypainniwhichcaselieisriotofsoundmind.Furthermore,Furthermore,theconsentri;abenegatedbyundueinfluencebothfromtntrelative’sandthedoctors
Since(hrpticritnearingdeathmaynothavethementalconditiontoconsenttodie,theParliamentaryBill1’J69suggestedthathicmaymakeadeclarationinadvancestatingtnathewshe5inccrtairicircumstancestob putpainlesslylodeath.Theprobleminthiscase5 thtmanitenanceofthatwishuptotheveryastmoment.THERELIGIOUSASPECT
TheRomanCatholicChurch,in PopePiusXll’sEncyclical,MysticCorponis,hasmadeclearitsrejectionofanyformofeuthanasia.TheArchb:shopofCanterbury,speakingintheHouseofLordsdebate1936echoedth.sameview.
TherearethreereasonswhyChristiansconidern:euthanasia.First,theyregardLimeashelengingtoGodManonlyholdsit iii tiList.IIchastheiiL’of t buthemaynotdestroyit atwill.Secomidlf.Christiansthinkthatnomanhastherighttotakeaninnocentlife.“Theinnocentandth just,the,:shaltnotkill”saysExodos(23:7)Thirdly,stiffeningfortheChristianis etanabsoRd’’evil,It maybeanoccasionforspiritualrowthandan
opportunitytomakeamendsforsin.Christiansshoedofferuptheirsufferingin unionwiththePassionoChrist.
AlthoughChristiansofficiallycondemn’euthanasia,onecanactuallyjustifyeuthanasiaonChristianprinciples.TherootofallChristianmoralityus“LoveGodandThyneighbour”.Lovewouldurgeustopermitoursufferingneighbourtochooseaneasydeathandtoobtainmedicalaidin implementingthatchoice.
PrintedbyShumShingPrintingCompan.Hoop,Kcrrg
TheScripturetellsus Blessedarethemerciful.”Ifweshowmercytoourdogsandcatsbyputtingthemto‘sleep”(whenwecannotreducetheirsufferings),whyshouldwebelessmercifultomenespeciallywhenmencanexpresstheirwishtodieandexpectthedoctortohelp?
SomemaysaythatitisGodswillthatweshouldusethereason,conscienceandfreedomofchoicewhichHehasgivenustofightagainsttheevilofa painfuldeathandseeka remedyfroma doctor.Alternatively,otherChristiansmaypresentthecompletereversewiththesameargument.THEETHICALASPECT
Thefirstethicalargumentinfavourofeuthanasiaisthatitiscrueltoallownumanbeingstolingerformonthsinthelaststagesoftheirlivesinagony,weaknessanddecayandtorefusethemtheirdemandsfordeath.It isalsocrueltoforcetherelativestoseetheirlovedonesinthedesperateplightinthelong-drawn-outprocessofdying.
ThesecondargumentisthatofLiberty.Thelibertyinvolvedisthatofthepatientaswellasthedoctor.Apatientshouldhavetherighttochooseadeathofdignityandrepose.Onthedoctorspart,ifhehonestlybelievedthatthebestservicehecanperformforhissufferingpatientistoaccedetohisrequestforeuthanasia,heshouldnotbeforbiddentorioso.
Thethirdargumentisthatthevalueoflifeisitsqualityandnotitsquantity.Severepaindemoralizespersonalityanddestroyspersonalintegrity,andthusnegatesthequalityoflife.Qualityisalsomeasuredbythevalueofanindividual’slifetothecommunity.
Howover,theconceptofthequalityoflife”isvague.Bywhatpossiblestandardcananybodyassessthelevelofqualitybelowwhichlifeisworthless?It isimpossiblefordeathtoimprovethequalityoflife.Theonlypossiblewayinwhichthedeathofanindividualcanbesaidtoenhancethequalityoflife,isstatistically:theeliminationofthelowerqualityliveswouldleavethesurvivorsshowingshowingahigheraveragequalityoflife.Butthisprincipleisinhumanandshowsnorespectfortheindividual.
Letusnowconsidertheethicalargumentsagainsteuthanasia.First,thereis theriskof an incorrectdiagnosis.Wecannotexpecttogivetheaveragedoctortheresponsibilityforendingapatient’slife.Thisdecisionisfallibleandtheconsequenceofthemistakeisirreparable.irreparable.Doctorscanbecarelessandunstableat times;theymightbemisguidedbya pitythatoverwhelmsjudgmnt.
It istruethatthepossibilityofa mistakedoesnotdetersocietyfrompursuinga particularlineofconduct-—if thelineofconductiscompelledbyneedwhichoverridostheriskofthemistake.Theneedforeuthanasiatorelievepammustbeverygreatbeforeonecantoleratethepossibiltyofa fatalmistake.
Moreover,thereistheriskofadministeringeuthanasiatoapatientwhocouldlaterhavebeencuredbydeveloprnentsdeveloprnentsinMedicalKnowledge.Whilethereislifethereishope.Theargumentagainstthisisthatnewdiscoveriesrequvea longtimebeforetheycanbeappliedgenerally
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Page2 CADUCEUS September,197’
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I hadnothingto sayat thatmoment,becauseIfeltit sohypocriticalif I weretogivehima wholelectureonwhyweshouldneverloseheartin thestruggleagainstegoism,etc,for afterall, how“selfless”am I, despitemy advocations?However, I do rememberhaving readsomewhere(darenotclaimcreditfor it forfearof possibleliability)that whateverservicewerenderotheristherentwepayforourlodgeonearth— andremember,whatwithinflationanddeflation,therentis boundto beontheascendencyascendencydaily(thetragedyof themodernman?!)
* * * * *Thatday,as I walkedoutof thelibraryaftera day’s“digging”,thesunsetseemedmore
beautifulthanever,andthe“flameof theforest”lookeda dazzlingblaze. Impetuously,I mademyselfpromisemyselfthatthroughouttheyearsof labouringthroughbooksandgruesomesights
(ContinuedfromPage1)andtherecanbecaseswherethedoctorsknowforcertainthatnothingshortofa miraclecouldrestorethepatientwithina briefperiod.
It isalsofeared,thatoncevoluntaryeuthanasiaislegalised,itwouldinevitablyextenditsscopetoallthosewhocouldbeshowntobea “burden”tosocietyThisisthewedgeargument.Allmoralquestionsinvolvethedrawingofa line,butthe“wedgeprinciple”holdsthatit is impossibletodrawa linebecausethelinewouldhavetobepushedfurtherandfurtherbackuntilallactionbecamevetoed.
THESOCIALASPECTVeryoften,it isthesocialaspectwhichgivesrise
tothepatient’swishtodie.Whateverthepatient’sbeliefabouthisfateafterdeath,thelossof lifeisaneventgreatlyfearedbyhumanbeings.Patientsonlywishtodiebecausetheyfeellonely,helplessandafraidthattheirremainingdayswillbringaboutmoresufferingforthemselves,themselves,moreburdentotheirfamiliesandmoretroubletosociety.Adoctorshouldremovethesewishesfordeathinsteadof submittingto them.In additionto givingtreatmentthatrelievespain,he shouldconsiderthepatient’spsychologicalproblemsan discussthemfranklywithhim.Heshouldre-assurehispatientthatheisnotgivinghimupbecauseofhisdiagnosis,thatit isabattletheyaregoingtofighttogether— patient,familyanddoctor.Sucha patientwillcontinuetohaveconfidenceinthedoctor.
Sincethedoctorswouldneverhavetimetodealwithboththemedicalandthesocialaspectsinthecareofterminalpatients,socialworkersshouldbeintroduced.Experiencehasshownthatin thesympatheticandsometimessurprisinglycheerfulatmospherecreatedbysocialworkershelpingin terminalhospitals,veryfewpatientswouldaskfordeathevenif euthanasiawerepermissible.ThisisactuallyadmittedbytheEuthanasiaSocietyinLondonin1936.It istruethatthereareveryfewoftheseterminalhospitals,andeffortsshouldbemadetobuildmoreofthesehospitals.
Inmakingdecisionsbetweenlifeanddeath,howmuchweightshoulda doctorgivetothewishesandresourcesofthepatientsfamily?HelenSilvingregardedthatthewishesofthefamilyshouldnotberelevantatall,andthateuthanasiashouldnotbeadministeredforthebenefitofa personotherthanthesufferingpatient.Thisbeliefisbasedonthetenetoftheequalvalueofallhumanbeingswhichbarsthesacrificeofoneindividual,however,uselessandburdensome,forthebenefitofanother,however,however,useful.However,onemustnotignorethefactthatif thefamilycannotsupportthepatient,theburdenwouldfallonsociety.If societyneedsitsresourcesforothermoreworthwhileprojectsthankeepingdyingpatientsalive,theformerwillhavetotakepriority.
Insteadof grantingrelief,euthanasiamaycausedomesticcomplication,guiltyfeelingsanddissensionsamongthemembersofthefamily.Itmayalsoimpairtherelationshipbetweenthepatientandhisfamily.
However,ifa patientgenuinelywishestodiebecausehewantsto relievehislovedonesof theburdenoflookingafterhim,it maybeconsideredunfortunatethat
hehastoimplementthisnobleandunselfishwishinalonely,miserableandsometimesmessyactofsuicide.Heneedshelpandadviceoversuchgravemattersashisdeathandif heknowsthatthedoctorwouldbesympatheticsympathetichewoulddiscussitwithhim,butatthemomentdisclosingthewishtocommitsuicidemeansimposingonthedoctorthedutytopreventhimfromdoingso.THEECONOMICASPECT
Letusfacethefact,resourcesarelimited.Manpower,finance,timeandspecialequipmentsastherespirators,usedforonepatientwilldepriveanotherpatientofthechanceofbenefittingfromthem.If patientswhohavenochancetorecoverareallowedtodie,resourcescanbefreedforthebenefitofpatientswhohavea betterchanceto recover.Withthe successof organtransplantation,theorgansoftheformercanalsobeusedtoreplacethoseofthelatter.Toaneconomist,deathhasanimportantparttoplayinthehumaneconomy.It eliminatesthewornoutandthosewhoseparthasalreadybeenplayedandmaintaintheadaptabilityofthehumanracetoaneverchangingenvironment.However,if euthanasiaisusedasoneofthewaystoeliminatethewornout,theproblemofselectionwouldariseastowhoshouldbeallowedtodieandwhoshouldnotbe. Thereisalsothecuestionofassessingatwhat
stageofanincurableillnesswoulditbereasonabletoendlife.CONCLUSION
Fromtheabovediscussion,it isclearthatthereisnoeasywayoutoftheeuthanasiadilemma.Doctorsopposetheideaforthefearofbeingbrandedaslicensedkillersandtoavoidadmittingdefeatinthefaceofillness.Diagnosiscanbewrong,diseasesclaimedto befatalpreviouslymightbecomecurablewithinthelife-spanofthepatientanda trulyinformedvoluntaryconsentisanidealimpossibletoachieve.Then,thereistheproblemofselection,thedifficultyofdefiningdeathandthefearthattherecognitionoftheindividual’srighttodiewouldmerelybethefirststeptowardsthestatecontroloftherighttolive.
Whileindividualswillcontinuetobeinfluencedbyoneormoreoftheaboveaspects,societyisunderanincreasingpressuretocometoa solutionweighingtheseaspectsagainsteachother.WhethereuthanasiawouldviolateChristianteachings,orunderminethedoctor-patientrelationshiporcreatea senseof insecuritywithinthepatient,orcausedomesticcomplicationsorgrantrelieftothemembersofthepatient’sfamily,are,infact,mattersmattersofopinion.Norcanthesolutionbefoundbyfollowingfollowingthehigh-soundingmoralprinciples,suchasLiberty,Cruelty,RighttoDie,QualityofLifeandEqualityofMenwhicharevagueanddebateable.
A doctormusttreateachpatientasanindividualpersonwhoselifehasphilosoohicalandtheologicalmiplications.miplications.Hemustmakehisdecisionanswerabletohisprofession,hisreligiousbelief,hisconscience,andthesociety.Alltheaspectssetoutabovehavetobecarefullycarefullyconsideredandbalancedagainsteachother.
Manis sucha self-centredcreature.Whenhe is happy,he is tooelatedto giveothersathought.Whenheissad,heissoengrossedinhisownmiserythattherestof theworlddoesnotexistfor him. It is onlywhenhe is idle,soidle,thathe suddenlyremembersthattheremaybeanotherfellow-manwhoneedsa willingear,a helpinghand.
mindednessof a childandnonchalanceof alunaticto maintainan integratedpersonality.
* * * * *Someonetoldmethathehasdecidedtobe
moreselfishbecauseit doesn’spaytobe“good”.
of sicknessandsufferings,I willstillbeablet(appreciatebeauty,soboldlyexhibitedin naturesoskilfullypresentedin thearts,andmaybeno’asexplicit(in fact,oftentoowellconcealed),itman. byD.
:
Should the Patient be ALLOWED TO DIE???
—
If therebelight,givemelight;
If therebepower,extendit tome;
If thereheforgiveness,forgive;
If therebetomorrow,grantmea hopein it;
if therebethesethings,butnotforme,givemethepatienceto endurethenot
having.At firstglancethisphilosophysoundedso
passiveandresigned.ButgraduallyI cametoappreciatethefaithandstrengthbehindit. Veryoften,weprayandwisheversoferventlyforthisandthat. Is it nothightimethatweask,notonlyfor whatwewantmost,butmorefor thecouragetoovercomefrustrationin caseof disappointment,disappointment,andthefaiththatthemorrowwillbringyetanotherbrightdayforusto tryagain?
* * * *
We are livingin a worldfull of people,peoplewitheyes,ears,mouths,6th senseandwhatnotsenses,thoughnotalwaysusedto thebestends.Ourstandardofjudgement,ourmoralcode,oursenseofvalues,ourmodeofbehaviour,areinfluenced,morethanwewouldliketoadmit,as everyonewantsto think that he is an“individualindividual”,by theopinionof thosearoundus. Whetherwelikeit or not,weareconstantlyunderthe controlof negativeandpositivefeedbackmechanisms.In theformer,wemaygiveupmanythingsduetosocialpressure;whileinthelatter,wegraduallycometothepointwherewefeelobligedto liveupto theexpecta:ionsexpecta:ionsof others,irrespectiveof ourownbeliefs.[n thishumdrumlivingwithitscomplexhumannteractionsonedoesneedsomeof thesimple- ByLife
Page3 C A D U C EU S september,1974
Amidstthepressureofcomingexaminationsandapprehensionoffailure,medicalstudentsbravelyfacethechallengesinSeptember,anunusualmonthof theyear— criticismsaswellasappreciationfromthepublicinexchangefor monthsof painstakingpreparationforthehealthexhibitiononGeneralHealth& CommonDiseases,toexpressourheartywelcometowardsthe150futurecolleagues,andyetnottoalarmthemwiththeimpendinghardships,inthefreshmenorientationprogramme,anda nightofenjoymentatLokeYewHall asa conclusionto theseriesof extra-curricularactivities.
Membersof theMedicalSocietyhavealwaysbeenconfrontedwiththeproblemof fittingintorealitythehopeof promotingfriendlyrelationshipamongfellowstudentsandbetweenstudentsandstaff. In retrospect,therearebutonlyfewoccasionswhentheseaimscanactuallybefulfilled.TheMedicNite,branded“grand”bythefewwhoappreciatethe“subtlety”ofthelanguage,isrejectedbythemajority.Participantsinsportsactivityjointheinter-yearsportscompetitionwithgoodintentionbut sometimesfindthemselvesrewardedwithanunhappyending.Therefore,onecanseethatwhatwearestilllackingisa commoninterestamongstudentsandbetweenusandthestaff(apartfromacademicinterest).It iswiththisinmindthattheMedicalSocietyorganizestheMedicConcert.It willbea nightofjointeffortbymedicalstudents,membersof theteachingstaff,fellowstudentsfromotherfaculties,studentsfromsecondaryschoolsaswell as a feweminentprofessionalsin theColony.Meanwhile,theMedicChoir,stillinitsembryonicform,awaitsthenurtureofthosewhosparetherprecioustimeattendingchoirpractices.
Wearegreatlyhonouredbygroupperformancesbymembersof theUnionChoirandstudentsfromsecondaryschools.Besidesbeinga friendlygesturetowardseachother,thisprovidesuswithanopportunitytoletthosewhoenvyusknowthat,nomatterhowmuchourfutureprofessionisbeingidolized,lifeaheadofmanyof usseemtobeasyetunknownandsoveryoften,wefeellikebeingblind-folded,strivingonlyfortheapparentlynearestgoalof passingtheM.B. Examinations.Geographicallyisolated,medicalstudentsarebarredfromparticipationin theextra-curricularactivityin themaincampus.Therefore,whatevermisunderstandingandestrangementbetweenbetweenmedicalstudentsandotherfellowstudentsthathavearisenthereof,orwhateverdivergentviewpointsonoursocialresponsibility,letusgraspthischancefor clarificationandas a steptowards —greaterunification,bothwithinandwithoutthefacultv.
----‘--‘\/-ç :1
I))
r-,3-zd6JtIED/CALSC/L7Y
AU.AR
k.
A questionnaire on studentopinion on the various facilitiesfacilitiesof the Medical Libraryhas been set recently and the
resulting data is now listedbelow.
(1) 9.3 of studentsthinkthattheopeningopeninghoursonMON,TUE.THU,FRI duringthesummervacationareadequate.30.7%ofthestudentsstudentsthinkthattheopeninghoursduringtheabovestatedperiodareinadequateandshouldbechangedfromthepresent9.00n.m.— 10.00p.m.to 9.0()n.m.— 11.00p.m.schedule.
(2) 40.5%of thestudentsthinkthat theopeninghoursonWED.duringthesummervacationvacationareadequate.59.5%of thestudentsthinkthattheopeninghoursduringtheabovestatedperiodareinadequate.Themajorityof themsuggestsuggestthattheLibraryshouldbeopenedfrom9.00n.m.— 10.00p.m.asopposedto the presenthoursof9.00a.m.— 7.00p.m.
(3) 62.1%of thestudentsthinkthat theopeninghoursonSAT.duringthesummertime
areadequate.37.9 of thestudentsthinkthatopeninghoursareinadequateandshouldbecxteiideJcxteiideJfrom9.00a.m.to 11.00p.m.asopposedtothepresent9.00a.m.to5.00p.m.
¶4) 24.6%of thestudentsthinkthatit isalLrightforthetihrarvto beclosedonSundaduringthesummervacation.75.4%of thestudentsstudentsthinkthatthe Libraryshouldbeopenedfrom9.00n.m.to 11.00p.m.intheabovestatedperiod.
(5) 40.8’ of thestudentsthinkthattheestablishmentof a 24 hoursopeningstudyroomisnecessary.59.2 of thestudentsthinkthatit
2 S.,?to -_ t:
isunnecessary.
I. MessagefromFraternityCornmittee1. FraternityNite
Date:25thSept.(Wed.)Time:7.30p.m.to10.00p.m.Place:LokeYewHallProgramme:Drama
—byseniorsandfreshmenMusicalitemsDebate—betweenseniorsand
freshmen2. Friendlymatches
—betweenfreshmenandseniors
FootballDate:4thOct.(Fri.)Time:5.30p.m.Place:SportsCenter
BasketballDate:9thOct.(Wed.)Time:5.30p.m.Place:SportsCenter
Messagefromtheclasses3rdyear—photographiccourseon developing
developingis to be held inSept.
—a campwasheldin ChekLapKokIsland(ft) on2ndSept.to 4thSept.
2ndyear—atrip to Macauwasmade
on 6th Sept.duringwhicha visit was paid to theKiangVu Hospital.
111．學群中同過近f化史圖結一展覽內容：介紹近百年來（1840一1974)西方列強對中國的侵晷及中國界、民奮起疋抗，追求獨立，富強，民主的；驕史。
口期：一月五汙至·日j也點：陸佑堂
(6 60.1 of thestudentsthinkthatthecheckingsystem’of theiibraryon the personIeaingit isefficient.39.9%ofthestudentsthinkthatit isinefficientandshouldbereinforced.
(7) 138studentsthinkthatthenewspapersareinsufficientin thelibrary.131studentsthinkthatthemagazinesandtheperiodicalsareinsufficientinsufficientin thelibrary.127studentsthinkthattheteserebooksareinsufficientin thelibrary.74studentsthinkthatthereferencebooksareinsufficientinsufficientin thelibrary.20studentsthinkthatjourn—alsareinsufficientin thelibrary.
(8) If thenewspapersareto beputin asngleplace52.2c of thestudentsthinkthatitshouldbe placedin thelibrary.24.4%thinkthatit shouldbeplacedinthecommonroomand23.4 thinkthatit shouldbeplacedin thecanteen.canteen.
(9 Somestudentsthinkthattheventilationn thelibraryispoor,theairconditionbeingtoonoisyandtoochilly.
(l0 Somestudentsthinkthatthepapercuttingpapercuttingmachinesshouldbe renewedbecausethepresentmachinesaretoooldandtooblunt.
(I I) Somestudentsthinkthattheborrowingborrowingperiodof booksonhalfdayloanshouldbeprolonged.Somehopethatthejournalscan beborrowedona 2 daysloanbasis.
(12) Somestudentsthinkthatin generalthelibraryis in lackof booksonChinesemedicine,medicine,proseof any language,jokes(eg. Mad,CharlieBrown)andChinesefiction.
Thanksto ourfellowstudentswho havevoicedtheirconstrucLieopinionandthusmadethecollectionof theabovedatapossible.
B thestudentrepresentatiesoftheMedicalLibran
廠三第 思 啟 月九年四七九一f上河桑準大學
》一他有心一一祕
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你可知道你為甚黃要 口J卜計才二伶日 日 日f于于j望中、抬戶
I選夾：丰一忽乎 i遺。一啊盪仁仰k ’主醒
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響于一以·衫縱坼‘久一：
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，驗個憚；化
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了。以
濟一）以佰人？一我鴃你的淚 地
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么一州名彎醫中。你田J么】尸．開祈伶
一中學汙名
'pjh,你乍L必陣．
一我求你
時間還多的是 。的、斗你蘆'jT;由卞、、一
J.丸魄？你這魔鬼
丰江j?7一斤州七，右州州我地‘么
我個人的工作能勺
一個打洛合考浚書
一你說可悲，
州U戶hc才j尸'J'？丁凡J 你分州州的k也H
義·二肉舞蠶j’ 、鼾勾取必理’的/（也州中訕' 州狙：認你n占勺！．汙化一”自h
司少。偶 合叫
一？騙州日寸他兀州‘ "r，。'大，？我 叮約你，付中名寫J莖我 吃了•此l勺''句戶
i丫華 跋你，內自寸光州。 方叮邢j斗、'r'i''屹》的吟．, J徒 化t真中孓結 ！他江不坏疋物
辭一紅平
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一中今仰。一耐'）中化U,、l,r
壯啊壯。
那時你不麩月此為玄既？你不
利川坪種。以式的方注去一。．州你的哎績嗎
）度以為那此．一化怔誠憊的讚嘆卜分但耳
，求你不要再說了，嚴我安靜來嗎？
兩年的頂科純粹是在虛榮的心填下，胡胡淚
半清解半迷惘中渡過。一直都自己欺騙自己
直至臨近考試前的兩個多月才開
“If a drugcouldbeproducedthathadtheanti-asthmaticpropertiesofsteroidswithouttheirside
effects,thetrialsandtribulationsofasthmaticpatientswouldbeat anend.”
Lancer(19662,1354.
steroid control without steroid side effects
ExtensiveclinicaltrialsofBecotideInhalerhaveshownthatit giveseffectivecontrçof asthmaticsymptomsin patientsareno longerobtainingadequaterefrombronchodilatorsorsodiumcromoccate.
In additionit hasbeenshownBecotideInhalertherapycanbeuseds cessfullycessfullytoreplacesystemicsteroids inasthmaticpatientsWhohavebecomeolddependent.
Inadouble-blindcontrolledtrialin ngasthmatictients,BecotideInhalerprovidedcontrol ichwasatleastaseffectiveasthatobt edfromoral‘prednisolone;theonlysigncantdifference’sthatplasmacortisollevelswerenotdepressedwithBecotide
intaleyheraPv.
ensuresforyourasthffective
asthffectivetreatmentcontrollingthepathologicalprocessesinvolvedin‘nchospasm,oedemaofbronchial
fmucosa,andhypersecretionofmucus.0 Freedmfromsteroidsideeffectsincluingadrenalsuppression.0 A fulI- andlessrestrictedlifeaadvantagejofsteroidtherapycanbeducedat earlierstageoftheC” A
PRESENBecotici
delivers-perinhalatprovides2C
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ha hu 1theneedicuIar nr theselectionmanagemerIpatients.
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I
始著急，在慌忙中每利以一咀得些少皮巨，f-[l．卻仍
心俘澆偉，以為已操勝券。
我很高與你仍然沒有敵開。
一我一直卻在你的身邊。
一你可以汰訴我今次失收的陳因嗎？么
一你失以壯因為你根木未曾想過以自己的真
中實力去應伺這次的考試而期諸澆偉，另一方面
文完全籬景在自我的虛榮化中。其實一氾，口低的失敗
州本不值得一顧。
為甚麼？你可知道我這次的失敗已物之了
我的前逮，使我的志願永誠達吹的
。一
一你獎死心眼，難道．次的哎以就能口定人
伯生？一可是我的家庭？···；·U
一你的家庭對你壯寄望極高的，你伶次的失
州無疑會令他們失望，但你可以日役的成就來滿
化他們，而他們亦會因你而感驕做。
可是我有、嗯嘆敗為勝的能勾嗎？
一你的能j還末真lI.1喪掘呢，快牛起，來，仁
上狗呆在這一畏，跑好的世界派在向你招手肥！
一．你說的不錯，可壯你．則以待訴我你是誰嗎
-·一我肌壯你思州中的波很，我的責任就他把
你衝擊嘆一個中吹的久。化低壯很，我二要抓斷的衝
州。
THE HONGKONGMEDICALASSOCIATION
All registereddoctorsinHongKongareeligiblefor RegularMembershipoftheHongKongMedicalAssociationandall medicalstudentscanjoinasStudentMembers.
Oneparticularprivilegeof regularmembersis thattheycanobtainmedicalprotectionbyjoiningtheMedicalProtectionProtectionSocietythroughthe HongKongMedical Association.Every doctor
shouldacquiremedicalprotection,includinghouseofficers.Eventhoseworkingin Governmentserviceshouldjoin theMedicalProtectionSocietybecauseif troublearisestheycannotexpectassistancefromGovernment.The MedicalProtectionSocietywilladviseyou,defendyouandindeminfyyouagainstdamagesandcosts.
JointheHongKongMedicalAssociation.ObtainapplicationapplicationformsfromtheAssociationPremises,WyndhamMansion,6thfloor,WyndhamStreet,HongKong,ortelephoneH-231898.Medicalstudentscanalsoobtainapplicationformsfromtheofficeof theHongKongUniversityMedicalSociety.
The EB wishesto thankthe specialsupportof GlaxoHongKongLimited.
遞 丑聖 ·．．⋯⋯⋯二 。一 - 一 一 一 生 一 直 一 一 一 一 一 一 一 二 望 獎 ‘八上接第一版一高等教育
（國內）：巾一州曾參觀南京的復口．大學，學
生多是叩己子弟，在入學前郡已在農付或卜廠必
動過一段時問。
闕？門大嗯：般勻取Jl’賺標准視此一磯）口家很不同
，汀一個學中排一安經也自汗巾。口，叩仳很排州頓
導批朧導投個卡界，至於久擊斗、劇〈口甲開紛用
全由國家負袒。
大學有學生？。為織織，。一狙伶搬、政，
同改進教法中果州，取一徒方的開件露續！中
校方並不狀悵在取學時網授甘于、，斤。！州她
的風氣在梭內州不盛行。
（臺．)：大學生都m）片孑樣、，時可畢辦文藝
活動，體育活動亦頗受重視，三民L．弄．復列一馮浮
一大學生必修的課神；在大學坐奠，男中計女生
的數目多，在社斤卜正男叔女洶情州偌然方在C
．般大件的學邵費用認多，統法人家仁化易
負扭，一曲政府助宇貸飲又不多，听1t一編家一中嗎卜
大學此較中付易。
（星加坡）:，中卸坤、方俗，。戶州。化
間在圖書館也貝到很多人抓書。
有學生合的紐織，其選舉制叮一俗）選答卜
名
Collnc-
llors，然俊再由C。自江11()1.5自己”他出
學生會幹事，一迪常在公選
COUnCillol.S時祝票最
多的便任會長，而一州職位又多巾才劉肥斗小仰心
我們在星時一這逢星大選舉，州辟聽叔的跋澤一11號
不外是要增加會方行政效車，門容騙鵝縱中，父
不爾視參與校政卜飄社會行政。
學徐一們都很以l'I己的國家喝欠，華個亦衣大
認同自己為中國人，、他種情形在！．勺一占民中亦可
察覺得到。我們曾和．此學生淡到政沽，仙們表一，J右竹
到中國大陸參觀，可能因為在州。加輪俗有公州桃
才可進入大學，而公民權可州隘時被遞奪，州常
這種情形都和政冶有關。
戶馬來西亞）：州）r生的卜午n州節便，男喪
學生的頭髮都很長，男生很輕
樂事，醫學生則比被斯文。
話，發覺他們不大門心學運佻，州掠友同忽r為
們竹和一嶼一柑·生談
而社合位沌以亦不高
可能為了配合將來的發展，理科人捆卹為llt
香，而一般大學生畢業後都能找到合適職業心
乃奉國）：大學生山有很多他京家戶鴻，他
可由他們所擁有的六車看出來，因為在泰國以小
是奢侈品，窮人很鐵買得起。
學生讀害頗夫碌，皺本是
exam古籌右：
orienta常d之流，曾見他們下午有測驗，卜午
還陪我們到處玩。
以前從報章上知道學生竟可以將舊政府弄垮
，便以為該地學運很蓬勃，但我們在各大學很少
見到標語，而以攪學運出名的汰政大學也不見有
甚麼特出的地方，據當地人說f．次的政變根木是
基於軍眾要求，常然大學生亦曾扮灰磚東鴨l(l色
，而無可否認大學生在社會f.頗有勢力。
《菲律賓）：大學的數目很名，(ll．有．那
分只是激芋充數，佔一幢縷宇的．．、．【．喘便算大
學，與香港的私立中學相若，當然卹具規校的大
學亦有，如
Universi擠。fP才iliP漁n。便很仁
浩，學生亦很勁l]，在第．年，卞邵學生都要瀆
又科。很多學生讀一商科，因為他們喜歡做文數，然
向很多時學非所用，有不少學生郁希焜能到美國
九一發發縱。與運並不突出，學卞對於代生活此授政下啊
工農業
國內）：州浩展曲天業為卜
、Jh開啊州）仁中森中
鵑：至州了，.，下一矗煮：t計’ 必他‘!．尤 f、化甲業。方、j、啊：穴寸鉤辭衍！兀麩j 。造化l 兀七’轔!r;:！不土翅1為乏！’寫斗l兀；亂喪）]'偽：時有進各y止抑？物而計俗近育挫·丫江堂話趙用羊育必l -！他沙；l必
臺灣）⋯般下
，對勿以易競嚼有利，我
們見到有啊少L廠，但
很多嗚外資拙制，其中
川、濺為土，幾J:．咸
抓兩間的狀濟哨民地必
（馬來西亞）:
甲往取儿（業，州我們洽
逮經過的地方來看，很
多地方已開騰，牌叫樹
矚目拷縫，州前政府離
頗姣欽資動私。潔拓終
口俗園，佻泥午織一勢論仁
再公勵牌俗園的沒l.,
可能馳與國際隊膠園的
價椅戊不穩有關。
（菲律賓）：個
抓j吧跑未地書其用，而國
家仔、展好像沒有領麼訓
劃，丰卜業卜分吃秀，
留工L擲能，儿外州
嗎k！收人每訂比．個
織通咋合口為多。
生活程度
乙國內）：沒有
[11一州（飾例入四公生j二訌邊•J!J
I付可兀， ，的I,, 一分
j州U州、祝，
別，就州仁
個L人干均
卜．儿l右，而人責玄遛
、J'．程師凍技術人
月入亦只是六
又因為般必需品
如米、汕、
給方可購買
（臺潤）：很多啼女有職業
以情侃比香港好。
（菲律賓）:
以日常生活並f如香港般緊張
馴窮人坐膩小時以卜，
見雖然貧rl;,；在亨受方rfll’南
L卜么,j.(lU搪作是依配
所以人民中盾比姣
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,Jj.'
一昌人小半小時飛
別，州機諱做得不語
情沈令國昀llit：衍惱利飼戶
('等S。
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均月人約七1-．化，而）閒普一也酒啊的房間每口亦
要匕卜化，〈般消費品價錢也‘便宜，听以休受
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嘆哄出來。娛（國內）
h化m看電馴兮
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內弄名年口
，匹少愛
在作城鎮有听謂 、郃中11教群一公園、
嗎，
門伶r、！了政
俗實L國內亦有很
壯市民流池內地方
lJ。抆有看兌或聽到有
能直有文壞上利。
口哎，叫了價亦嚥宜，[性或付藝才壯×州k化 久、抓叮走
抆然甬久！州H、l辭么es、退劉
,．一一啊11!j 名1，。
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戲劇、俘樂、丈術、舞路、仳棋，芥類學州斑，
縱有圖縫口宇，問A宇等。
色悄俳業可以況州無你有。
（臺灣）:11常消遣以看電衫、訂公園嗎tll
m。遍，扯麻產姣右如秀港l．一．然心曰，頃，一離今令
·、向歡閱讀。夜總台設備抓淡占彿准好，仁過尼吟．地）]’彼
不呈．般人、听能負州件來，至）it：紅燈區l't'.J情妃叫
右大清羋，但男同學在們店時頗頻彼久問叫“仰
姑頓匕陪。
（星加坡伶：滿Ij為絨）)jl昤尚川安好，民風
樸不，啊枓山有色情俗戰公然斤作，伐們司憑．
條人沃街，ri’次有機台看到不男不女的S日日
（即不縫多e，又不糙him)，在大庭廣眾面
前騷件不芻，他（或她》們．部紛造為J錢，另
．部份則頗嚮往女性生活才做這和L作。
（馬來西亞）：巾以影很。。徒，有卜中秀港
製作的舊啊語片L映，內你郃壯描述Il-、叔卜年
伏香講時化社淬州。低，听l.J、六地．儿：仁到過否准
的f、州波一雌州候香灘偽淤．個占·為保守的城狗
（泰國）：朮州院淡仃撇派，化•。亦很拍，
右此：故綱久斤港還卡L映，。！！與償戶也便卹，
．叮，騙儿以叮矚方侈勾！、支。
色佩”業極之蓬抽，仃中；的l.,,u饑竟然
將印派（喂。，的皓片八卜，浩竹到過料玲區韋
觀的同n，各絕抑汰色情今巳坏有，斗斤鵝他
，一問乍州口徒。
匕降任卜口‘亂
（菲律賓）:
1一，刈1•qd計
.'.‘'i!!k '國并必雙劍
頃擊 l【討寧州州的綱縱
;
（國內）
門例 佻 l 1l丁軾丁獲織扑 J一k與降必。江
騙、！咸一 、公一本.d臘
往巾以想較八目
（台灣）
卜丫、mJ
rj,1亡J州‘計洶．rJ‘人1'‘償f1
哦J化圳 黴憮飄件劇 1必，-！界伶波j
問安
！鯽;,r吃馭斤衍月加斗閑卜
}-. }'1',l!'，、i：。．斤而斗 j紜抆訕、
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仁1!j ．。,, 111。-!-．妒，！、：
在晚迅街由
1111，趁．l’能巾
業灘有關，在
時鼠以7,)'J：可
（奉國）
舉ll．給
理化！
女嘔
)lJ矣頭·久
-．揮野磯嚥
右宜久街r
口概一夕一。
（菲律賓）:
中很中提待叩案，治
伏仃久勸告戊們小必
兇役認離寥
k學仗法口劉州川刻川×閔”j
同時償械在奉亦
件悄，川嗎擄加女j'．的
听扯觸的年久椰很搜
卞潤似乎l你鐫，
州向。
刊
物
（國內）：在句．地臨仃．、
,l(lJ’洛國件的報紙IllJ有久民報
論性文低。時事訢
逢尼屯遜F、，而獄土‘I 111·月二較少，
仁過作曦
兩份地作糾報
，比內六多矚
我fl''l逗悄胡問滿
般反啊邵很中淡tl這秦鰓遍'
瀉，報
有一付叫鬥參考消息以的刊物，縫節錄殊地
的報離消息，其中包括香港、台灣等，川．抓公閒
發挪，通帘能夠看到的造川娥份二J或行那大‘綴？
占刊有析學，政一、科做、文癸相。樂等多
方而，．般久邵寫歡陶廠小此，而大而湯的《玲
邸有一。傳坎斤卜義內亡味，中徒占吹、‘、宇作師刻
你少一他o還有山州爾州大一報，很名時．壯作k
如iiiJL其，然而化州．兄，並l'：足全邢州卜。
，仃此．讓具占傳引的，如川防傳染病便化
（菲律賓）：報州劉國際新開有險
妒以，以．矓小狗，衫，面報試內古以物、令
？歡化，J，淡f抑小甲伏文·風格模仿讓、國
八州方夕．？、并句，人撇補類繁名，
騰l、翅。向，有很1崗的州啊古務都可以
化潔作一，人二仲，·州人織雙合八洶，
交（國內）
(．台潤）
開：甲織'，色
.狀砍！
州騰目·！J;入，l ’、·目勺；’水：，斗！：、視你州：江《，弘勵！、口鰍朧寨
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其她國家，人華數址參覦名勝古蹤
亦仃听F同，作國內U以同胞視之
中國在巡些年卡的發喊和成就 ！勿J雙lf‘編，在其
以一巾州沐一州·熙
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州Lfll計仰
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一明，州
在午次的陣淡神，談話的”代斤先提出．惆
中亡也11：明牧育，醫療等，而由各同學就他們
到勸的地。作：”紹，凍先希州在交流臘問之外
，史能將幾側地徊作．比較，然ll'lj取片在將紀錄
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鵝到國內f11夫比池地的兩抓，到國內峨仃的同
學叩tlljl結抱八時識新中國精神而貌的心情而去
，叔於其俄的同學則或名或少他懷狗遊玩的口的
；因l(lj友家听然限的目標便戲然卜同，在國內·
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在援待）,’面
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仃啊同），所J.')．純粹壯內業l.．的交往。
茶於l．述原因，要將各佃地方作）比較是
卜可能的，然幸大多數同學郎能利；lJ能們敏規的
觀察）]，听謂見敞知片，因而仍可粗異看出在不
同社吋制度卜不同的表現，然lflj究竟楚否吸是瞎
弋換取，情中窺豹呢？不過無論如何，通過今次
的吸淡，大家總沐能交流、點峨遊的感想。
版一第 一 一一 一 一 -,’間尸陶•．,','向一•’，．•口，．• 一一，角•叫間網•．--，向門，，一一州，••
香泳大學學生會
醫
學
會
月
刊
六
巷
九
期
木期發行四
份
一九必四年九月
- 、一 一 - 一、H、h'內'‘一、國、‘、‘'.，、、．,‘•“,,，、•d'“•、'j界、．,'',,'，、綢‘ 、•、',' '','v，．州．、,
自古人類便察覺到音樂與醫療的關係，希
臘的阿婆羅是音樂、詩歌與舞蹈之神，亦
是健康之神。派得格拉斯八P牌
hagoras）認為
食物及音樂乃清淨靈魂肉身，使其和諧的因素
，柏拉圖亦以音樂為導
致兒量身心健全的一個
方法。由於這些覺察，無
論在理論和實際上，音
樂和醫學一直都維持相
當的互相影晌；在文藝
復興時期，有人提議把
希波格拉底斯（鬨召p。
ArateS）的醫學理論應
用到音樂去。有名的軍
醫安布魯士．巴爾（
＞日
broise
Par.e）把
啟思錄
棗棗嶔棗棗辦嶔巍眾樂謝嶔寡謝棗畿為誠豪棗親辦親棗辦鐵戒棗眾棗鐵嶔嶔棗棗棗棗襯棗棗巍謝襬棗辦蹤崧擊礬孱 響裊筆臺浩巢喬高秦驃器豐邑鑿 認喜暈 孵黝膠娜網友的目醫、，其會舍院學解容樂快深階一或歡義邁在 亂么、．盆森’么嘿A聖裊仔喬巒署羹丰墨量父咨呼幕擊在霧露齋甲氈苧斤 羈蘇慇嫻讖祈丁暈于鞏靨響霄翕翕盡量暴擊瞿豪臺粟暈 森攣譽 戶鉍網甲在任無面益，中，，來會同高遇掌多適對 這院生 個．， 、．未重論發，適國隨大，的學班到握姿應新 我，荒 ，蓄斗俗勰來道是展盡量周之學已活亦同疑知多；的 們加之 中k ：亦吋瀾的遠那。使的、而學有動可學難識釆但環 對入聲b二視 乍黑嘗斗不 玄合古麥售濺譽黑常，k鑿幣下擊 整然率中 鑿：分 ，。騙月讓班 學與學還會少是過尤貝程！以感 生們下遛亂繆叮rlkl 麒中我的 生不的有的迎多互其要中醫肯到 力的，之 憎 一 ’勗們， 活僅開展、新樣相導提，學定陌 軍行百實 二 。界螂栽耗都 罷罷駁覽屬鰍花衍前茁定茹而搬 表死丰 孑縱 J攀界出共有 在促日會會動的助、，有識是， 示，位 、, ’一 ’才篡團同共 德進等、的！" ，更老無既，都 熱倍新 勿一為黔驕：馴凍辦嶔嶔棗親嶔謝謝嶺親齋辦辦棗齋棗辦齋樂樂棗親棗辦辦謝織親親樂親樂親親棗齋謝崙齋巍謝棗樂棗辦以
醫學院。
音樂看作是醫治蜘蛛毒，坐骨神經痛及風痛的
良藥。直至現代，音樂在醫學上很多方面已佔
有無可置疑的地位。如在物理治療、心理治療
、職業治療、麻醉學等，它都有其特別用途。
醫
學
院
向
你
們
招
手
港大學生是否一斑自以為是的特權階級，一
草這個社會制度下之寵兒，既得利症者？醫學院
大部份學生是否滿腦子金錢、地位、甘心為專利
壟斷制度而自肥嗎？這些都將要暴露在一拿剛踏
越大學門檻的祈同學面前。在世界潮流的推動下
，港大同學的面貌可曾轉變f？同學們是否安心
於把自己關鎖在狹隘的象牙塔中？可以肯定的是
：沈迷於個人名利的逐鹿從而渾渾罐噩的讓生命
無聲無臭地紹走的思想已為時代所摒棄，而我們
也相信新同學們也不是為社會給與大學生在就業
前途和生活待遇的特殊地位而進入港大，尤其是
不錯，很多新同學可能還未能了解自己讀大
學，唸醫科的目的；有些可能認為考試的成績次
定了他所要走的道路。這當然不能全部把它歸咎
於中學教育的失敗，枯桂青年思想的填鴨奴化教
育已令多少有崇高理想的同學們被拒於大學門外
；社會對大學生的態度也促使學生讀書的目的模
糊起來·政府是在培養一些怎麼樣的大學生？
大學裹的環境較中學的開放。生活的圈子擴
大了；以前小圈子的三數知己已被學生會及其各
屬會多姿多釆的活動所吸收及組織起來。個人的
接觸面擴大了，同學間的思想交流促使了和啟發
f對人生目的，生存意義和現存真理的懷疑和探
討。和中學時期的不一樣，思想受到多方面的影
晌而得到鍛鍊、成長；不再滿足於學制內的框框
；轉而著重個人人生觀的培養。社會的發展已令
我們再不能安於鴕鳥式的生活。隨著眼界的開放
·胸襟的舒展，確立奮鬥目標的耍求益趨殷切。
那麼正確靈活的利用課餘；處理課內外的學習、
活動不是比中學的書本生涯，考試奴隸生活更有
意義嗎？
，審．．各．唔．會，會，絮，×叉匹×玉匹．審盒
因此，我們不難看到醫生與音樂家合併的
例子。有名的外科專家比洛夫（中iurot,）也
是有名的音樂評論家、鋼琴家、小提琴家和中
提琴家。伯拉姆斯可算是他最知心的朋友。波
羅汀醫務繁忙，但他
口口口口二 實
獸 馨
痲學
那麼，
天份的人。
都會知道。
業餘之作J(?)：
中亞細亞草原、伊
高皇子使他永垂不朽
。近世來說·我們首先
當可想到史懷惻·
沒有人敢否認他在這兩
方面的崇高地位。而本
世紀最偉大的鋼琴家巴
德瑞夫斯基（Pade；織
品叮）和小提琴家克萊
斯勒（州常訪州r)，也
是習醫出身的。
我們醫學院當然也不會缺少有音樂
沒錯過九月廿一日醫科音樂會的人
東
風
知識份子可愛的地方在於熱衷於尋求真理，
接受真理，對現存制度的不平最易醒覺。他的使
命感促使他對不平作出反晌、提出改造。但要做
事論事不脫離實際！符合客觀要求，就必須努力
衝破自己周圍的局限，身體力行，走到各階層中
體會他們的疾苦，了解他們的喜樂；培養一個不
脫離人草、不脫離社會、國家甚至世界的人生觀
，從而確立將來的服務對象。
我們醫學生已漸漸從過去的課室、圖書館、
宿舍的刻板生活抽脫出來！慢慢地學會利用課餘
·從無意義的分數包袱解放出來。但是功課袒子
還是重的，是掌捉服務人草的本領的重要環節。
旦是，伐們將來的職業，分工上的崗位，更需要
旦是，伐們將來的職業
我們認識社會的本質，
角落正向我們招手，
的希望。
斗
國內、
國外
讀萬卷書，不如行萬里路
友
今年著假，多位同學曾到外地遊覽！尤以二
年級的同學（現在已是三年級了）為數最多，其
中十數位為了交流在旅遊中的見聞，在八月下旬
時作了一次非正式的座談，在輕鬆愉快的氣氛下
互相傾吐在旅途中的際遇和感受，筆者有幸叨陪
末座·亂縴'' 'l
現就當日傾談內容簡述一遍，希望藉此與
其他同學一 ”一？!
je
'A紙，畏 更需要我們了解社會上那
正向我們露出一絲絕望中
同分享旅遊的樂趣
地方逗留的時間甚短
可能只是片面的認識，
在逗留期間，
來所謂赤腳醫生·
治病之餘亦參加勞動。
醫學訓練，全部以實用為主
小病不出隊，
理論少，但對
〉 曄然而因為在每
，所見都是一鱗半爪
所以就此拋磚引玉
其他見聞更多更深的同學，不吝賜教。
醫
療
（國內）：在用藥方面以西藥為主
輔，現在的趨勢是中西醫結合治療。
的單位），因為赤醫的學習精神很好，
有很多藥房是看病賣藥，女雍疥很裂一到拍，
，腳痛則賣腳痛藥，但都只是Sym鷺omat片曰r
Aat日en計·作用相信是喊輕診所醫生的負但。
在參觀上海第六人民醫院時，很高興見到斷
肢再植的病人，他們通常要數個月才可康復，但
痊癒得很徹底，細微的動作都可以做。
回溯斷肢再植的手術始於十數年前．當一班
醫生接觸到貧下中農時，了解到四肢對工農的重
要，所以在六三年時，有某一工人意外斷手，醫
生們便考慮到要為他保存手部，經過多次努力，
克服重重困難，最後終於得到重大成就。例如最
初的病者很容易發生水腫，經過研究·發現原來
因為動脈血壓比靜脈大，而當初接駁動脈的數目
多靜脈數目則少，因而引致
Venous
Return受
阻硯，同時淋巴系統又未能充分接駁成功，所以
形成水腫，因此在以後的手術中便儘量接駁多些
，因而，希望 靜脈
，一般工農都可以
，以便血液循環得以暢通。
醫學制度採用三年制（這是在文革後制定
還在漠索階段），注重對病的診斷和醫治
現時還在模索階段）,
，中藥為
曾有機會接觸到赤啣醫生，原
只是指他們不脫離生產，即在
他們約受半年左右的基本
般農村常見的病也能應付褚如。 畢業後而並非在醫院服務的
醫院學習一段時期
見到很多人購買，
甚高
大病不出社（隊和公社都是農村
雖然基本免費服務的。醫學院大多是六年制
現在很多都赴英攻讀。，隔一年左右便要同
國內人民甚喜歡閱讀醫書，每每在書局都會
很多人購買，可見他們的醫學衛生知識水平
在街道上曾見到有教導預防疾病的大字報！
對提高一般人的衛生情況很有帝助。
（台灣）：有很多私家醫院，大部份規模都
很少，只佔三幾層樓，有些醫院甚至沒有醫生駐
診，因為有些醫生在出洋前將醫院轉讓，而接手
者未必是醫生，所以造成有醫院而無醫生，在該
等醫院，診病由護士袒任。
有些公立醫院的病人雖不多，但工作人員效
率則甚低，往往填寫一張表格也要多重手續，診
金是按病情而定，我們有位同伴病得頗重，結果
花了三十元，另一位比較輕微的，收費只是十二
元。我們曾見在路旁有由高班醫學生袒任的晨早
健康檢查；如替老年人量血壓、心跳等，相信是
，另加一年實習，在低
年班有輔助科目如哲學、歷史等。
醫學生在暑假時受三個月軍訓，據說畢業後
要當兩年軍醫才可以執業，雖然醫生外流的情形
頗嚴重，但又不覺有醫生荒的情形。
（星加坡）：有很多診所是由數個醫生共
同開設的，看病的人很多，不過診症頗詳細，公
立醫院設備比香港差得多，在星只得一間醫學院
，但因人口少，所以醫生比率高於香港。
（馬來西亞）：醫學院制度和香港差不多
，第一年讀完
PreClinical
Course，第二年讀
完
Paracinical
Course，第三至五年讀完C江三
A閑1CO肩Se。
可能因為華僑子弟多能勤奮向學！所以華人
習醫的很多，最近的政策是儘量錄取多些本地人
·但他們水準低，閔
Xternal
Exa日iner不滿意
他們的成績，所以馬來西亞現在的醫學生不為英
聯邦醫學會所認許？至於有志學醫的華僑子弟，
（菲律賓留：有很多醫生出口！可能是因
為大學太普遍！所以形成醫生過剩。
（下轉第二版）
