對死亡不實際的態度 (3)

對死亡不實際的態度 (3)

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)

This physical and emotional distance becomes obvious as we make decisions that accompany life’s end. Suffering is like a fire: Those who sit closest feel the most heat; a picture of a fire gives off no warmth. That’s why it’s typically the son or daughter who has been physically closest to an elderly parent’s pain who is the most willing to let go. Sometimes an estranged family member is “flying in next week to get all this straightened out.” This is usually the person who knows the least about her struggling parent’s health; she’ll have problems bringing her white horse as carry-on luggage. This person may think she is being driven by compassion, but a good deal of what got her on the plane was the guilt and regret of living far away and having not done any of the heavy lifting in caring for her parent.

隨著我們伴隨生命結束所作的決定，這個肉體與感情的距離就變得明顯。受苦像一團火，坐得最靠近它的人，感覺熱度最高(喩：與病患親屬住得愈近，愈體會到其病痛)。而燃燒的照片是發不出熱度的。(喩：住得愈遠的子女，僅憑相片懷念無法明白他/她的痛苦)典型上，這是為什麼曾經親身最靠近父母病痛的子女，最願意讓父母走。(但有例外，Bill Gates-微軟老闆明知道罹患癌症母親的痛苦，也知道病情回天乏術，卻仍千方百計-尋求最近醫藥與醫療要挽回母親的命，其實只是延長其痛苦。) 有時與父母不同住或遠離的子女說，『他/她下周即將搭飛機回來，把父母的病搞定』通常，這是最不暸解為病症掙扎的父母的子女；她還會有點麻煩要把她的白馬當隨身携帶行李帶上飛機。這位女兒自以為是因父母之同情心所驅使，其實大部分要搭機回來探望生病父母的原因，是內心的愧疚與懊悔住得太遠，絲毫未能盡到照顧父母，以減輕其病痛的負担。

With unrealistic expectations of our ability to prolong life, with death as an unfamiliar and unnatural event, and without a realistic, tactile sense of how much a worn-out elderly patient is suffering, it’s easy for patients and families to keep insisting on more tests, more medications, more procedures.

由於不切實際地期望我們有能力延長生命，把死當成陌生與非自然的事，並缺乏實際與實体的感受到一位身心疲憊老邁父母所受的痛苦，所以病人與家屬就易於斷地堅持做要更多的試驗、服更多的药物和做更多的檢騐手續。

Doing something often feels better than doing nothing. Inaction feeds the sense of guilt-ridden ineptness family members already feel as they ask themselves, “Why can’t I do more for this person I love so much?”

為病患父母盡點力總比沒有好。當家庭成員捫心自問，『為什麼我不能為我深愛的人多盡點力? 』時，對父母未出力，給了他們早就有的羞愧無力感。

Opting to try all forms of medical treatment and procedures to assuage this guilt is also emotional life insurance: When their loved one does die, family members can tell themselves, “We did everything we could for Mom.” In my experience, this is a stronger inclination than the equally valid (and perhaps more honest) admission that “we sure put Dad through the wringer those last few months.”

選擇嘗試各種醫療與檢查手續，來減低內心的愧疚也是感情的生命保險。當親人過世，家人可以自我安慰，『我們對母親已盡了力』。依我的經驗，這是比同樣有效的承認更具強烈的傾向，或是更誠實的承認說，『在父親臨終前幾個月，我們的確幫他度過了痛苦』。

At a certain stage of life, aggressive medical treatment can become sanctioned torture. When a case such as this comes along, nurses, physicians and therapists sometimes feel conflicted and immoral. We’ve committed ourselves to relieving suffering, not causing it. A retired nurse once wrote to me: “I am so glad I don’t have to hurt old people any more.”

在人生某一階段中，積極的醫療也許會變成受制裁的折磨。當像這樣的病例持續下來，護士、醫生、醫療師有時侯會感到內心衝突與不道德。我們一直承諾要減輕病人的痛苦而不是引起痛苦。一位退休護士寫信告訴我，『很高興不必再傷害老病患了』

When families talk about letting their loved ones die “naturally,” they often mean “in their sleep” — not from a treatable illness such as a stroke, cancer or an infection. Choosing to let a loved one pass away by not treating an illness feels too complicit; conversely, choosing treatment that will push a patient into further suffering somehow feels like taking care of him. While it’s easy to empathize with these family members’ wishes, what they don’t appreciate is that very few elderly patients are lucky enough to die in their sleep. Almost everyone dies of something.

當家屬們談到要讓其親人『自然』死亡時，他們的意思常是指『壽終正寢』，當然不是指可以醫療的病症，例如：中風、癌症、或疾病感染。選擇讓病人死亡而未醫療他，家屬們感到罪惡感；相反地選擇治療而逼迫病人進一步受苦，卻多少感到是照顧了他。雖然同情家屬們的願望是容易的，可是他們所不能體會的是，很少老年病患都能『壽終正寢』。幾乎每一位病患的過世都有各種不同情况。

Close friends of ours brought their father, who was battling dementia, home to live with them for his final, beautiful and arduous years. There they loved him completely, even as Alzheimer’s took its dark toll. They weren’t staring at a postcard of a fire; they had their eyebrows singed by the heat. When pneumonia finally came to get him, they were willing to let him go.

我們親蜜的好友將他們患有癡呆症的老父親帶回家同住，好讓他度過最後美好，但想艱苦的餘年歲月。在家他們對他付出完完整整的愛，甚至當愛玆海默病使它付出嚴重代價。他們不會注視有火燒的明信片，他們讓手肘燒傷。當肺炎終於取走他的命時，他們願意讓他走。

- by a Medical Doctor一位醫生, posted on Washington Post, 06/15/2013  (登於華盛頓邮報)

全文完

【譯者評註】：

似乎有智慧的東西方人士，對年老親人病亡的看法都是理智的，雖然子女的態度與觀念或有不同。但能體會老人的病痛，而樂見親人早日離開的子女畢竟較少。醫生對病人家屬的開導，也許可以減輕病人本身及親人，在財政與情感上的負担。但不是每位家屬均可接受，尤其在台灣，病人為避免被責為『不孝子女』，皆會盡其所能予以救治，而主治醫生也會自動或被動地予以配合，一則本身業績提高，醫院收入增加，二則也博得『良醫』之美名。

其實，人體像一部機器，雖因人保養程度之有所不同，但都有一定的使用期限，因年老體衰而逐漸接近死亡是不可逆轉的 (irreversible) ，而現代醫學再發達恐也無能力，無法治活『壽命該終』的老人。若能讓親屬適時地體會到，『既使神仙也救不了無命人』的自然法則 (natural law)，則病人與家屬都會覺得心安理得，双方了無遺憾。 Just let it be……

Justin Lai 譯註

09/18/ 2013

嘉中校友會

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