對死亡不實際的態度 (2)

對死亡不實際的態度(2)

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)

The bulk of that decline came in the first half of the century, from simple public health measures such as improved sanitation and nutrition, not open heart surgery, MRIs or sophisticated medicines. Similarly, better obstetrical education and safer deliveries in that same period also led to steep declines in maternal mortality, so that by 1950, average life expectancy had catapulted to 68 years.

死亡率減少的主因是在前半個世紀，由於簡單的公共衛生措施的進步，例如改善的衛生與營養，並非開心手術、心臟血管掃描、或傳統的醫學。同樣的，在那個時期，更好的產科教育與更安全的分娩技術，也導致產婦死亡率急劇下降。因此到了1950年平均壽命已推高至68歲。

For all its technological sophistication and hefty price tag, modern medicine may be doing more to complicate the end of life than to prolong or improve it. If a person living in 1900 managed to survive childhood and childbearing, she had a good chance of growing old. According to the Centers for Disease Control and Prevention, a person who made it to 65 in 1900 could expect to live an average of 12 more years; if she made it to 85, she could expect to go another four years. In 2007, a 65-year-old American could expect to live, on average, another 19 years; if he made it to 85, he could expect to go another six years.

儘管科技技術與沈重的價格標誌，現代醫學與其是延長或改善老年，倒不如說是使老年生活複雜化。如果一個人在1900年能活過童年，那麼她就大有機會能存活到年老。依照疾病防治中心的看法，在1900年能活到65歲就有希望平均多活12年；能活到85歲就有希望再多活4年。在2007年一位65歲的美國人可望平均多活19年；如果他活到85歲，他可望多活6年。

Another factor in our denial of death has more to do with changing demographics than advances in medical science. Our nation’s mass exodus away from the land and an agricultural existence and toward a more urban lifestyle means that we’ve antiseptically left death and the natural world behind us. At the beginning of the Civil War, 80 percent of Americans lived in rural areas and 20 percent lived in urban ones. By 1920, with the Industrial Revolution in full swing, the ratio was around 50-50; as of 2010, 80 percent of Americans live in urban areas.

我們對死亡否認的另一因素，與不斷改變的人口統計的關連遠比醫學上的進步多。我們國家大量離開農地與農業生活，而走向更城市化的生活型式，意謂我門已經很冷靜地遺忘了死亡與自然世界。美國內戰開始時，百分之80人口住在農村，百分之20人口住城市。到了1920年隨著工業革命全面的進展，城市與農村的人口比例是一半一半。到了2010年百分之80美國人住在城市。

For most of us living with sidewalks and street lamps, death has become a rarely witnessed, foreign event. The most up-close death my urban-raised children have experienced is the occasional walleye being reeled toward doom on a family fishing trip or a neighborhood squirrel sentenced to death-by-Firestone. The chicken most people eat comes in plastic wrap, not at the end of a swinging cleaver. The farmers I take care of aren’t in any more of a hurry to die than my city-dwelling patients, but when death comes, they are familiar with it. They’ve seen it, smelled it, had it under their fingernails. A dying cow is not the same as a person nearing death, but living off the land strengthens one’s understanding that all living things eventually die.

對於多數生活在有人行道與街燈城市的我們，死亡已經變成少見與稀罕的事。我在城市長大的小孩所經歷過最逼真的死亡，就是在全家外出釣魚之行中，看到偶而被釣上的大眼魚，或是一隻被石頭砸死的松鼠。大部分人吃的鷄肉都包在塑膠套內，而非在大劈刀之末端。雖然我所醫治的農夫們不會比城市病人更急著去死，但當死神來臨時，他們卻能安然以對。他們已看見它，嗅到它，也觸及到它。垂死的水牛與臨終的人雖不一樣，但依賴土地為生之想法，强化人們的理解-萬物生命皆會死。

Mass urbanization hasn’t been the only thing to alienate us from the circle of life. Rising affluence has allowed us to isolate senescence. Before nursing homes, assisted-living centers and in-home nurses, grandparents, their children and their grandchildren were often living under the same roof, where everyone’s struggles were plain to see. In 1850, 70 percent of white elderly adults lived with their children. By 1950, 21 percent of the overall population lived in multigenerational homes, and today that figure is only 16 percent. Sequestering our elderly keeps most of us from knowing what it’s like to grow old.

大量城市化，並非一直是使我們遠離生命圈唯一的一件事情。逐漸增加的財富，已讓我們隔離了衰老。沒有養老院、扶助養老院、聘用家庭護士等制度之前，祖父母、兒女與孫兒們三代同堂，生活在同一屋簷下，每人的奮鬥情形清楚可見。在1850年代，百分之70白種老人與兒女同住在多世代的家中。到了1950年代，全人口百分之21數代同堂。今天只有百分之16。隔離了我們的老人，使我們多數人無法明白年老的資味與感覺。

Justin Lai 譯註

09/2013

嘉中校友會

AACHW13