2015年经济学人 家中安息 家庭援助

 

Dying at home

家中安息

Home help

家庭援助

The government wants you to have a comfortable (and cheap) death

政府愿您安乐（又经济）的告别人世

Still, it's better than hospital

家还是比医院好

DEATH comes to all, but some are more sure of its timing¹, and can make plans. Kate Granger, a 32-year-old doctor suffering from an incurable² form of sarcoma, has “very strong ambitions” for her last hours. She plans to avoid hospital emergency departments and die at her parents' house—music playing, candles glowing, family by her side.

每个人都会死，但是有些人却更加清楚自己何时会死，且可以提前做好计划。32岁的凯特·格兰格是一位医生，却身患无法治愈的恶性肿瘤，她对自己剩下的时间有巨大的野心。她不打算死在医院的急诊室，而是她父母的房子—音乐为歌，烛光为舞，亲人相伴。

Surveys show that over two-thirds of Britons would like to die at home. Like Dr Granger, they want to be with family and free of pain. Yet hospital remains³ the most common place of death. For some this is unavoidable—not every disease has as clear a turning point as cancer—but for others a lack of planning is to blame. The government, motivated by both compassion⁴ and thrift⁵, wants to help.

调查显示，三分之二的英国人都意欲在家面对死亡。就像格兰格医生一样，他们想在亲人身边，免受病痛折磨。然而医院仍旧是死神降临最常见的地方。这在某种程度上是不可避免的—不是每种疾病都像癌症一样有一个明显的转折点—但是对其他疾病来说，缺乏规划则应负主要责任。在同情心和节俭理念共同的驱使下，政府需要伸出援助之手。

In death, at least, public wishes align⁶ neatly⁷ with the state's desire to save money. The NHS has calculated that if roughly one more patient per general practitioner⁸ died outside hospital each year, it would save 180m ($295m). In 2008 it introduced a broad end-of-life care strategy, which sought to increase awareness⁹ of how people die while improving care. Since then the proportion of people dying at home or in care homes (the split is about half-and-half between them) has increased, from 38% to 44%.

至少在面对死亡时，公众的愿望刚好和国家想要省钱的愿望结合在一起。英国国民健康保险制度已经大致计算出，如果每年每个普通医师医治的病人在原来的基础上增加一个选择死在医院外面，就会节省1.8亿英镑（约合2.95亿美元）。2008年，国家介绍了一个大范围的临终关怀方案，意欲在提升护理的同时增加人们对如何死亡的认知。自那时起，选择死在家里或者老人院的人数（以上两种情况大约五五开）已经从38%增加到了44%。

To steer¹⁰ patients away from hospitals, general practitioners¹¹ have been encouraged to find their 1%—those patients likely to die in the next year—and start talking about end-of-life care. This can be difficult for doctors. “As a profession we view death as failure,” says Dr Granger. Yet when there is no cure to be had, planning for death can be therapeutic¹² for patients.

为了引导病人们出院，普通医师已经开始鼓励找到那1%即将在下一年离世的病人，并且开始对他们采取临终护理。对医生来说这很困难。格兰格说“作为医生，我们将死亡看做失败”。即使没有什么治疗方法，为死亡做好充分的计划对病患来说也是有益的。

Those who do plan ahead are much more likely to have their wishes met. A growing number of patients have electronic “palliative-care co-ordination systems”, which allow doctors to register personal preferences so that other care providers can follow them. A paramedic called to a patient's home would know of a do-not-resuscitate order, for example. One study showed that such systems increase the number of people dying in their homes.

提前计划的人更有机会实现愿望。越来越多的病人都有了电子“疗养协调系统”，这使得医生可以把个人喜好输入系统，其他疗养提供者可以按医生嘱咐执行。比如说护理人员给病人家里打电话，会了解到他们不愿再接受治疗的愿望。一调查显示，这个系统增加了在家死亡的人数。

But savings¹³ for the government may mean costs for charities and ordinary folk. At the end of life it is not always clear who should pay for what. Although Britons can get ordinary health care without paying out of pocket, social care is means-tested. People must often shell out for carers or care homes—or look after the terminally ill themselves. Disputes crop up over trivial things, like responsibility for the cost of a patient's bath.

但政府的存款可能要支付慈善机构和普通人的花费。生命走到尽头，谁应该为什么付钱并不明了。虽然英国人可以不用掏腰包就获得普通的医疗保健，社会福利仍然有待检验。人们必须为照护者或者养老院付钱—或者亲自照顾末期病患。在小事上经常出现纠纷，比如病患洗澡的费用该由谁承担。

A bill now trundling through Parliament would cap the cost of an individual's social care. Still, some want it to be free for those on end-of-life registries. That would cut into the government's savings—but allow more people to die as they want.

一项通过议会的议案可以覆盖个人社会福利的费用。仍有一些人希望那些生命即将走到尽头的人可以获得免费的社会福利。这将会直接减少政府储蓄—但也会让更多人以自己想要的方式告别人世。

1 timing   

n.时间安排，时间选择

参考例句：

• The timing of the meeting is not convenient.会议的时间安排不合适。
• The timing of our statement is very opportune.我们发表声明选择的时机很恰当。

2 incurable   

adj.不能医治的，不能矫正的，无救的；n.不治的病人，无救的人

参考例句：

• All three babies were born with an incurable heart condition.三个婴儿都有不可治瘉的先天性心脏病。
• He has an incurable and widespread nepotism.他们有不可救药的，到处蔓延的裙带主义。

3 remains   

n.剩余物，残留物；遗体，遗迹

参考例句：

• He ate the remains of food hungrily.他狼吞虎咽地吃剩余的食物。
• The remains of the meal were fed to the dog.残羹剩饭喂狗了。

4 compassion   

n.同情，怜悯

参考例句：

• He could not help having compassion for the poor creature.他情不自禁地怜悯起那个可怜的人来。
• Her heart was filled with compassion for the motherless children.她对于没有母亲的孩子们充满了怜悯心。

5 thrift   

adj.节约，节俭；n.节俭，节约

参考例句：

• He has the virtues of thrift and hard work.他具备节俭和勤奋的美德。
• His thrift and industry speak well for his future.他的节俭和勤勉预示着他美好的未来。

6 align   

vt.使成一线，结盟，调节；vi.成一线，结盟

参考例句：

• Align the ruler and the middle of the paper.使尺子与纸张的中部成一条直线。
• There are signs that the prime minister is aligning himself with the liberals.有迹象表明首相正在与自由党人结盟。

7 neatly   

adv.整洁地，干净地，灵巧地，熟练地

参考例句：

• Sailors know how to wind up a long rope neatly.水手们知道怎样把一条大绳利落地缠好。
• The child's dress is neatly gathered at the neck.那孩子的衣服在领口处打着整齐的皱褶。

8 practitioner   

n.实践者，从事者；(医生或律师等)开业者

参考例句：

• He is an unqualified practitioner of law.他是个无资格的律师。
• She was a medical practitioner before she entered politics.从政前她是个开业医生。

9 awareness   

n.意识，觉悟，懂事，明智

参考例句：

• There is a general awareness that smoking is harmful.人们普遍认识到吸烟有害健康。
• Environmental awareness has increased over the years.这些年来人们的环境意识增强了。

10 steer   

vt.驾驶，为…操舵；引导；vi.驾驶

参考例句：

• If you push the car, I'll steer it.如果你来推车，我就来驾车。
• It's no use trying to steer the boy into a course of action that suits you.想说服这孩子按你的方式行事是徒劳的。

11 practitioners   

n.习艺者，实习者( practitioner的名词复数 )；从业者（尤指医师）

参考例句：

• one of the greatest practitioners of science fiction 最了不起的科幻小说家之一
• The technique is experimental, but the list of its practitioners is growing. 这种技术是试验性的，但是采用它的人正在增加。 来自辞典例句

12 therapeutic   

adj.治疗的，起治疗作用的；对身心健康有益的

参考例句：

• Therapeutic measures were selected to fit the patient.选择治疗措施以适应病人的需要。
• When I was sad,music had a therapeutic effect.我悲伤的时候，音乐有治疗效力。

13 savings   

n.存款，储蓄

参考例句：

• I can't afford the vacation,for it would eat up my savings.我度不起假，那样会把我的积蓄用光的。
• By this time he had used up all his savings.到这时，他的存款已全部用完。