對死亡不實際的態度 (1)

對死亡不實際的態度 (1)

Our unrealistic attitudes about death, through a doctor’s eyes (透過醫生的看法，下列是我們對死亡切實際的態度)

『譯者註』：

下列文章乃一位美國醫生對死亡的看法。

台語說『一樣生，百樣生』意即生的方式僅有一種，但却有千百種死法。一般人之往生分自然死亡-natural death與意外死亡-accidental death，前者都指『壽終正寢』，也是人們的最愛。後者則包括天災、人禍與疾病感染(infection)，方式多種，不一而足。文中强調站在醫生的立塲，看到年老病患與病魔纒鬥之種種痛苦，而當他/她病入膏肓時，不論有無意識知覺，或願不願意，自已皆作不了主，一切要聽子女們的擺佈。子女用盡一切醫藥與醫療救治，並以為是延長(prolong) 親人生命，也以為在盡孝道，其實是在拖延與增加他/她臨終前的痛苦…. 下面請看他的觀點：

I know where this phone call is going. I’m on the hospital wards, and a physician in the emergency room downstairs is talking to me about an elderly patient who needs to be admitted to the hospital. The patient is new to me, but the story is familiar: He has several chronic conditions — heart failure, weak kidneys, anemia, Parkinson’s and mild dementia — all tentatively held in check by a fistful of medications. He has been falling more frequently, and his appetite has fallen off, too. Now a stroke threatens to topple this house of cards.

我知道此通電話要打到何地。我正在醫院查病床，一位樓下急診室的醫師正和對我談話，提及一位需住院的老病人。這個病人我陌生，但故事聽過。他有好幾個慢性病-心臟衰竭、腎衰、貧血病、柏金森症、和癡呆症。所有這些症狀皆試探性地用一堆藥物掌握監視中。他的狀况一直比平常衰退中，他的食慾已喪失。現在一個中風威脅要顛覆這一大堆的病歷。

The ER physician and I talk briefly about what can be done. The stroke has driven the patient’s blood pressure through the roof, aggravating his heart failure, which in turn is threatening his fragile kidneys. The stroke is bad enough that, given his disabilities related to his Parkinson’s, he will probably never walk again. In elderly patients with a web of medical conditions, the potential complications of any therapy are often large and the benefits small. It’s a medical checkmate; all moves end in abdication.

這位急診室醫師和我短暫談起能做的辦法。中風已迫使其血壓高升，而使心臟衰竭惡化，也因此威脅到他虛弱的腎贜器官。鍳於因巴金森症導致四肢的癱瘓，這個中風會惡化到使他以後永遠無法走路。對於患有許多疾病的老患者，任們何治療的潛在併發症大，而治療效益少。這是醫療上的死棋：所有的每一步走法都導致下了全面的投降棋局。

I head to the ER. If I’m lucky, the family will accept the news that, in a time when we can separate conjoined twins and reattach severed limbs, people still wear out and die of old age. If I’m lucky, the family will recognize that their loved one’s life is nearing its end.

我走到急診室。如果我運氣好的話，病患家屬會接受這個訊息-雖然我們處在醫學發達的時代，可以分割連體嬰，縫接裂開的四肢，但人還是會因體衰而老死。如果我運氣好的話，病患家屬會承認他們親人的生命已近尾聲。

But I’m not always lucky. The family may ask me to use my physician superpowers to push the patient’s tired body further down the road, with little thought as to whether the additional suffering to get there will be worth it. For many Americans, modern medical advances have made death seem more like an option than an obligation. We want our loved ones to live as long as possible, but our culture has come to view death as a medical failure rather than life’s natural conclusion.

但是我的運氣不永遠那麽好，家屬也許會請我利用我醫師的超人力量來强迫病人疲憊不堪的身體再活下去，而未想到，為繼續讓病人活下去，所受的額外的折磨是否值得。對許多美國人而言，現代醫學的發達，已讓死亡看起來更像選擇而非義務。雖然我們希望親人盡可能長壽，可是我們的文化終於認清死亡是醫療的失敗，而非生命自然的結束。

These unrealistic expectations often begin with an overestimation of modern medicine’s power to prolong life, a misconception fueled by the dramatic increase in the American life span over the past century. To hear that the average U.S. life expectancy was 47 years in 1900 and 78 years as of 2007, you might conclude that there weren’t a lot of old people in the old days — and that modern medicine invented old age. But average life expectancy is heavily skewed by childhood deaths, and infant mortality rates were high back then. In 1900, the U.S. infant mortality rate was approximately 100 infant deaths per 1,000 live births. In 2000, the rate was 6.89 infant deaths per 1,000 live births.

隨著對現代醫學延長壽命能力的過度高估，同時人們常開始了這些不切實際的期待。這種錯誤的觀念也因過去一個世紀來，美國人壽命戲劇性的增加而更煽風點火。如果你聽到在1900年美國人平均壽命是47歲，2007年是78歲，你也許會有個結論，從前並無許多老年人，是現代醫學才發明了『年老』。(註：即醫學延長人類的壽命)但平均壽命因童年死亡而嚴重偏高，而當時嬰兒死亡率是高的。在1900年美國人嬰兒死亡率大約是1000人有100人。在2000年是1000人則只有6.89人 (未完)

Justin Lai 譯註

09/16/2013

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