2023考研英語(yǔ)閱讀書評(píng)臨終關(guān)懷

　　Book Review;Terminal care

　　書評(píng);臨終關(guān)懷

　　Go gentle into that good night;

　　溫和地走入那個(gè)良夜;

　　The Best Care Possible: A Physician s Quest toTransform Care Through the End of Life. By IraByock.

　　《可能是最好的醫(yī)護(hù)手段：一位內(nèi)科醫(yī)生試圖改革生命盡頭的醫(yī)護(hù)方法。》Ira Byock著作。

　　Asked where they would like to spend their last days, Americans almost always say at home,surrounded by people they love. In real life, though, only one in five achieves that. More than30% die in a nursing home, where almost no one wants to be, and over half end up in ahospital, often in an intensive-care unit, heavily sedated and attached to life-savingequipment until their doctors give up the battle.

　　對(duì)大多數(shù)美國(guó)人來(lái)說(shuō)，倘若最后的時(shí)光能在家中度過(guò)，周圍環(huán)繞著摯愛(ài)親朋，便是走也能走得稱心了。然而，只有五分之一的人能實(shí)現(xiàn)這個(gè)愿望。誰(shuí)也不想去療養(yǎng)院，可卻有超過(guò)三成的人死在那里;另外有超過(guò)半數(shù)的人死在醫(yī)院的重癥監(jiān)護(hù)室里，身上注射了大量鎮(zhèn)定劑，連接在生命維持設(shè)備上，直到醫(yī)生宣布投降。

　　Death is a difficult subject for anyone, but Americans want to talk about it less than most.They have a cultural expectation that whatever may be wrong with them, it can be fixedwith the right treatment, and if the first doctor does not offer it they may seek a second, thirdor fourth opinion. Litigation is a constant threat, so even if a patient is very ill and likely todie, doctors and hospitals will still persist with aggressive treatment, paid for by the insureror, for the elderly, by Medicare. That is one reason why America spends 18% of its GDP onhealth care, the highest proportion in the world.

　　死亡對(duì)所有人來(lái)說(shuō)都是個(gè)難題，相比之下美國(guó)人卻很少談起死亡。在他們的文化里，大家都覺(jué)得不管生了什么病，只要醫(yī)治得當(dāng)就能安然無(wú)恙;如果一個(gè)醫(yī)生不行，他們就會(huì)去找第二個(gè)，第三個(gè)，第四個(gè)他們還常常威脅著要起訴醫(yī)生，所以就算有人病入膏肓，行將就木，醫(yī)院和醫(yī)生也會(huì)堅(jiān)持實(shí)施高強(qiáng)度治療，反正年輕人有保險(xiǎn)公司付賬，老人也有醫(yī)療保險(xiǎn)撐腰。所以，美國(guó)的醫(yī)療支出占GDP的18%，高居全球之首。

　　That does not mean that Americans are getting the world s best health care. For the past 20years doctors at the Dartmouth Institute for Health Policy and Clinical Practice in NewHampshire have been compiling the Dartmouth Atlas of Health Care, using Medicare data tocompare health-spending patterns in different regions and institutions. They find that averagecosts per patient during the last two years of life in someregions can be almost twice as high as in others, yet patients in the high-spending areas donot survive any longer or enjoy better health as a result.

　　花了最多的錢，未必就能得到最好的衛(wèi)生保健服務(wù)。20年來(lái)，新罕布什爾州達(dá)特茅斯衛(wèi)生政策與臨床實(shí)踐學(xué)院一直在編纂《達(dá)特茅斯衛(wèi)生保健地圖冊(cè)》。該學(xué)院使用醫(yī)保數(shù)據(jù)，比較了不同的地區(qū)和醫(yī)療機(jī)構(gòu)衛(wèi)生保健支出之間的差異。研究者發(fā)現(xiàn)，雖然在生命最后兩年中，有些地區(qū)病人的平均支出可達(dá)其它地區(qū)的兩倍，但是他們的壽命沒(méi)有延長(zhǎng)，健康狀況也不比其它地方好。

　　Ira Byock is the director of palliative medicine at Dartmouth-Hitchcock Medical Centre and aprofessor at Dartmouth Medical School. His book is a plea for those near the end of their lifeto be treated more like individuals and less like medical cases on which all availabletechnology must be let loose. With two decades experience in the field, he makes a goodcase for sometimes leaving well alone and helping people to die gently if that is what theywant.

　　Ira Byock是美國(guó)達(dá)特茅斯希契科克醫(yī)療中心的姑息療法主管，也是達(dá)特茅斯醫(yī)學(xué)院教授。他在書中懇請(qǐng)人們把那些生命盡頭的人當(dāng)做人來(lái)看待，別把他們當(dāng)成冷冰冰的醫(yī)療個(gè)案，也別把他們當(dāng)成各種醫(yī)療措施的跑馬場(chǎng)。Ira Byock從業(yè)已有二十載，在書中為姑息療法做了強(qiáng)有力的辯護(hù)。如果人們只想走得安詳些，便不應(yīng)該徒生枝節(jié)，而應(yīng)該幫助他們滿足心愿。

　　That does not include assisted suicide, which he opposes. But it does include providing enoughpain relief to make patients comfortable, co-ordinating their treatment among the differentspecialists, keeping them informed, having enough staff on hand to see to their needs,making arrangements for them to be cared for at home where possibleand not officiouslykeeping them alive when there is no hope.

　　但是要滿足病人的心愿，并不意味著幫助他們自殺，Ira Byock也反對(duì)自殺。相反，姑息療法應(yīng)該為遭受劇痛折磨的病人緩解痛苦，與其它醫(yī)療專家協(xié)同合作治療病人，讓病人了解治療情況，保證有充足的人手為病人服務(wù)，還盡可能為病人提供上門服務(wù)。當(dāng)大限到來(lái)之時(shí)，也不將病人強(qiáng)留于世。

　　This is slippery territory. The Medicare Hospice Benefit act, passed by Congress 30 yearsago, offers palliative care to those expected to die within six months, but requires that oncethey take it up, treatment for their condition must stop. That puts many patients off. Andwhen they hear palliative care and hospice, their usual reaction is, I m not that far goneyet. Yet hospice patients typically last only two or three weeks. As Dr Byock says, this hasbecome brink-of-death care.

　　姑息療法處境尷尬。美國(guó)國(guó)會(huì)30年前通過(guò)了《臨終關(guān)懷醫(yī)療保障法案》，為那些預(yù)期壽命只有6個(gè)月的病人提供姑息療法。但是根據(jù)該法案，病人一旦選擇了姑息療法，就不得再接受對(duì)其病癥的治療，使得許多病人望而卻步。而且人們聽(tīng)到姑息療法或者臨終關(guān)懷，總會(huì)覺(jué)得：我的情況還沒(méi)有那么糟吧。所以，大多數(shù)接受臨終關(guān)懷的病人往往只能生存兩到三周。正如Byock所說(shuō)，這成了死亡邊緣的關(guān)懷。

　　Nor is it easy to decide when to stop making every effort to save someone s life and allowthem to die gently. The book quotes the case of one HIV-positive young man who was acutelyill with multiple infections. He spent over four months in hospital, much of the time on aventilator, and had countless tests, scans and other interventions. The total bill came to over$1m. He came close to death many times, but eventually pulled through and has nowreturned to a normal life. It is an uplifting story, but such an outcome is very rare.

　　究竟何時(shí)可以不再盡一切努力挽救病人的生命，而是放手讓他們從容走向死亡?很難判斷。書中便舉出了一個(gè)例子：從前，有一位青年身患艾滋病，病情危重，并發(fā)多種感染。他在醫(yī)院里度過(guò)了四個(gè)月，大多數(shù)時(shí)間都連在呼吸機(jī)上，做了許多次檢測(cè)、掃描和其它干預(yù)治療，最后醫(yī)療總賬單超過(guò)了100萬(wàn)美元之巨。他曾一次次瀕臨死亡，最終卻挺了過(guò)來(lái)，過(guò)上了正常的生活。這是個(gè)讓人振奮的故事，但是如此美好的結(jié)局很少出現(xiàn)。

　　Dr Byock s writing style is not everybody s cup of tea. The patients personal stories are toldin minute detail, leaving the reader gagging at the degree of physical and psychologicalsuffering that is most people s lot towards the end of their lives. And the author gets rathermessianic, advocating a more caring society that shows no sign of materialising. But he issurely right to suggest better management of a problem that can only get worse. As lifeexpectancy keeps on rising, so will the proportion of old people in the population. And with75m American baby-boomers now on the threshold of retirement, there is a limit to what thecountry can afford to spend to keep them going on and on.

　　Byock博士的寫作風(fēng)格可能不會(huì)合所有人的胃口。他把病人的故事事無(wú)巨細(xì)地一一寫出，讓讀者對(duì)多數(shù)人死亡前將要面對(duì)的心理和生理折磨感到窒息。作者也有些以救世主自居，在書里宣揚(yáng)一個(gè)不太可能出現(xiàn)的更有愛(ài)心的社會(huì)。不過(guò)，他說(shuō)要妥善處理一個(gè)必將越來(lái)越嚴(yán)重的問(wèn)題，這是對(duì)的：隨著預(yù)期壽命不斷提高，老年人口的比重也會(huì)越來(lái)越大。如今，美國(guó)嬰兒潮中出生的7500萬(wàn)人即將退休，國(guó)家財(cái)力有限，無(wú)法在生命的路途中將他們送上一程一程又一程。

　　Book Review;Terminal care

　　書評(píng);臨終關(guān)懷

　　Go gentle into that good night;

　　溫和地走入那個(gè)良夜;

　　The Best Care Possible: A Physician s Quest toTransform Care Through the End of Life. By IraByock.

　　《可能是最好的醫(yī)護(hù)手段：一位內(nèi)科醫(yī)生試圖改革生命盡頭的醫(yī)護(hù)方法。》Ira Byock著作。

　　Asked where they would like to spend their last days, Americans almost always say at home,surrounded by people they love. In real life, though, only one in five achieves that. More than30% die in a nursing home, where almost no one wants to be, and over half end up in ahospital, often in an intensive-care unit, heavily sedated and attached to life-savingequipment until their doctors give up the battle.

　　對(duì)大多數(shù)美國(guó)人來(lái)說(shuō)，倘若最后的時(shí)光能在家中度過(guò)，周圍環(huán)繞著摯愛(ài)親朋，便是走也能走得稱心了。然而，只有五分之一的人能實(shí)現(xiàn)這個(gè)愿望。誰(shuí)也不想去療養(yǎng)院，可卻有超過(guò)三成的人死在那里;另外有超過(guò)半數(shù)的人死在醫(yī)院的重癥監(jiān)護(hù)室里，身上注射了大量鎮(zhèn)定劑，連接在生命維持設(shè)備上，直到醫(yī)生宣布投降。

　　Death is a difficult subject for anyone, but Americans want to talk about it less than most.They have a cultural expectation that whatever may be wrong with them, it can be fixedwith the right treatment, and if the first doctor does not offer it they may seek a second, thirdor fourth opinion. Litigation is a constant threat, so even if a patient is very ill and likely todie, doctors and hospitals will still persist with aggressive treatment, paid for by the insureror, for the elderly, by Medicare. That is one reason why America spends 18% of its GDP onhealth care, the highest proportion in the world.

　　死亡對(duì)所有人來(lái)說(shuō)都是個(gè)難題，相比之下美國(guó)人卻很少談起死亡。在他們的文化里，大家都覺(jué)得不管生了什么病，只要醫(yī)治得當(dāng)就能安然無(wú)恙;如果一個(gè)醫(yī)生不行，他們就會(huì)去找第二個(gè)，第三個(gè)，第四個(gè)他們還常常威脅著要起訴醫(yī)生，所以就算有人病入膏肓，行將就木，醫(yī)院和醫(yī)生也會(huì)堅(jiān)持實(shí)施高強(qiáng)度治療，反正年輕人有保險(xiǎn)公司付賬，老人也有醫(yī)療保險(xiǎn)撐腰。所以，美國(guó)的醫(yī)療支出占GDP的18%，高居全球之首。

　　That does not mean that Americans are getting the world s best health care. For the past 20years doctors at the Dartmouth Institute for Health Policy and Clinical Practice in NewHampshire have been compiling the Dartmouth Atlas of Health Care, using Medicare data tocompare health-spending patterns in different regions and institutions. They find that averagecosts per patient during the last two years of life in someregions can be almost twice as high as in others, yet patients in the high-spending areas donot survive any longer or enjoy better health as a result.

　　花了最多的錢，未必就能得到最好的衛(wèi)生保健服務(wù)。20年來(lái)，新罕布什爾州達(dá)特茅斯衛(wèi)生政策與臨床實(shí)踐學(xué)院一直在編纂《達(dá)特茅斯衛(wèi)生保健地圖冊(cè)》。該學(xué)院使用醫(yī)保數(shù)據(jù)，比較了不同的地區(qū)和醫(yī)療機(jī)構(gòu)衛(wèi)生保健支出之間的差異。研究者發(fā)現(xiàn)，雖然在生命最后兩年中，有些地區(qū)病人的平均支出可達(dá)其它地區(qū)的兩倍，但是他們的壽命沒(méi)有延長(zhǎng)，健康狀況也不比其它地方好。

　　Ira Byock is the director of palliative medicine at Dartmouth-Hitchcock Medical Centre and aprofessor at Dartmouth Medical School. His book is a plea for those near the end of their lifeto be treated more like individuals and less like medical cases on which all availabletechnology must be let loose. With two decades experience in the field, he makes a goodcase for sometimes leaving well alone and helping people to die gently if that is what theywant.

　　Ira Byock是美國(guó)達(dá)特茅斯希契科克醫(yī)療中心的姑息療法主管，也是達(dá)特茅斯醫(yī)學(xué)院教授。他在書中懇請(qǐng)人們把那些生命盡頭的人當(dāng)做人來(lái)看待，別把他們當(dāng)成冷冰冰的醫(yī)療個(gè)案，也別把他們當(dāng)成各種醫(yī)療措施的跑馬場(chǎng)。Ira Byock從業(yè)已有二十載，在書中為姑息療法做了強(qiáng)有力的辯護(hù)。如果人們只想走得安詳些，便不應(yīng)該徒生枝節(jié)，而應(yīng)該幫助他們滿足心愿。

　　That does not include assisted suicide, which he opposes. But it does include providing enoughpain relief to make patients comfortable, co-ordinating their treatment among the differentspecialists, keeping them informed, having enough staff on hand to see to their needs,making arrangements for them to be cared for at home where possibleand not officiouslykeeping them alive when there is no hope.

　　但是要滿足病人的心愿，并不意味著幫助他們自殺，Ira Byock也反對(duì)自殺。相反，姑息療法應(yīng)該為遭受劇痛折磨的病人緩解痛苦，與其它醫(yī)療專家協(xié)同合作治療病人，讓病人了解治療情況，保證有充足的人手為病人服務(wù)，還盡可能為病人提供上門服務(wù)。當(dāng)大限到來(lái)之時(shí)，也不將病人強(qiáng)留于世。

　　This is slippery territory. The Medicare Hospice Benefit act, passed by Congress 30 yearsago, offers palliative care to those expected to die within six months, but requires that oncethey take it up, treatment for their condition must stop. That puts many patients off. Andwhen they hear palliative care and hospice, their usual reaction is, I m not that far goneyet. Yet hospice patients typically last only two or three weeks. As Dr Byock says, this hasbecome brink-of-death care.

　　姑息療法處境尷尬。美國(guó)國(guó)會(huì)30年前通過(guò)了《臨終關(guān)懷醫(yī)療保障法案》，為那些預(yù)期壽命只有6個(gè)月的病人提供姑息療法。但是根據(jù)該法案，病人一旦選擇了姑息療法，就不得再接受對(duì)其病癥的治療，使得許多病人望而卻步。而且人們聽(tīng)到姑息療法或者臨終關(guān)懷，總會(huì)覺(jué)得：我的情況還沒(méi)有那么糟吧。所以，大多數(shù)接受臨終關(guān)懷的病人往往只能生存兩到三周。正如Byock所說(shuō)，這成了死亡邊緣的關(guān)懷。

　　Nor is it easy to decide when to stop making every effort to save someone s life and allowthem to die gently. The book quotes the case of one HIV-positive young man who was acutelyill with multiple infections. He spent over four months in hospital, much of the time on aventilator, and had countless tests, scans and other interventions. The total bill came to over$1m. He came close to death many times, but eventually pulled through and has nowreturned to a normal life. It is an uplifting story, but such an outcome is very rare.

　　究竟何時(shí)可以不再盡一切努力挽救病人的生命，而是放手讓他們從容走向死亡?很難判斷。書中便舉出了一個(gè)例子：從前，有一位青年身患艾滋病，病情危重，并發(fā)多種感染。他在醫(yī)院里度過(guò)了四個(gè)月，大多數(shù)時(shí)間都連在呼吸機(jī)上，做了許多次檢測(cè)、掃描和其它干預(yù)治療，最后醫(yī)療總賬單超過(guò)了100萬(wàn)美元之巨。他曾一次次瀕臨死亡，最終卻挺了過(guò)來(lái)，過(guò)上了正常的生活。這是個(gè)讓人振奮的故事，但是如此美好的結(jié)局很少出現(xiàn)。

　　Dr Byock s writing style is not everybody s cup of tea. The patients personal stories are toldin minute detail, leaving the reader gagging at the degree of physical and psychologicalsuffering that is most people s lot towards the end of their lives. And the author gets rathermessianic, advocating a more caring society that shows no sign of materialising. But he issurely right to suggest better management of a problem that can only get worse. As lifeexpectancy keeps on rising, so will the proportion of old people in the population. And with75m American baby-boomers now on the threshold of retirement, there is a limit to what thecountry can afford to spend to keep them going on and on.

　　Byock博士的寫作風(fēng)格可能不會(huì)合所有人的胃口。他把病人的故事事無(wú)巨細(xì)地一一寫出，讓讀者對(duì)多數(shù)人死亡前將要面對(duì)的心理和生理折磨感到窒息。作者也有些以救世主自居，在書里宣揚(yáng)一個(gè)不太可能出現(xiàn)的更有愛(ài)心的社會(huì)。不過(guò)，他說(shuō)要妥善處理一個(gè)必將越來(lái)越嚴(yán)重的問(wèn)題，這是對(duì)的：隨著預(yù)期壽命不斷提高，老年人口的比重也會(huì)越來(lái)越大。如今，美國(guó)嬰兒潮中出生的7500萬(wàn)人即將退休，國(guó)家財(cái)力有限，無(wú)法在生命的路途中將他們送上一程一程又一程。