[2007.4.8][转贴][APTX青山病院]五分之一的人会“不体面地”死去 －－ 会是你吗？

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[U]http://www.medicalnewstoday.com/medicalnews.php?newsid=66847[/U]

One In Five People Will Face A 'shameful' Death - Could It Be You?

Article Date: 04 Apr 2007 - 1:00 PDT

Most people are unprepared for the shameful reality of how they could die, warns the author of a new book charting the social history of dying.

Although the majority of people imagine they will grow old and die in their sleep, surrounded by friends and family, one in five people will die what previous generations would consider a 'shameful' death - alone, ravaged by dementia and without dignity.

The deaths of more than half of the population will be 'managed' by medical professionals following serious injury or ill-health, with a small proportion dying suddenly, and often unexpectedly.

The rapid increase of the shameful death is being fuelled by an ageing population and a lack of foresight over how to deal with the ultimate consequences of the medical advances which keep people alive for longer.

"Most people think only fleetingly about how they will die, and usually it surrounds some romantic notion of dying in our sleep at home," said Allan Kellehear, Professor of Sociology at the University of Bath and author of the new book A social history of dying (please note - this is NOT an academic text).

"This notion couldn't be further from the truth; we are significantly more likely to die a lonely prolonged death in a nursing home or hospital, preceded by multiple organ failure, pneumonia or dementia.

"As we live longer, there is every chance that we will outlive those friends and family who would have traditionally seen us through our last years. It is also likely that we will have exhausted the financial means by which we would pay professionals to look after us instead.

"Dying today is becoming increasingly tragic and antisocial.

"The way we die is important because it is the last act of life, and plays an important role in how our friends and relatives will remember us.

"Some people spend years dying, and for many of the one in four of us who currently end our days in a nursing home, those last years can be like a living death.

"The way we care for our dying is a true reflection on how a society cares for its people; and it has to be said that the way we treat our dying in developed countries around the world is truly shocking."

A social history of dying charts the experience of death from the remains of the early humans through to the experiences of people today. Kellehear has used on his own research on the topic and has drawn on human and clinical sciences literature of dying from around the world.

"The early humans mostly died of predation, but as soon as settlements sprang up, we started living longer but dying of the diseases that affect our farmed animals," said Kellehear.

"From then on we see the emergence of two main kinds of death: the 'good' peasant death surrounded by friends and family and the 'well-managed' death overseen by shamans and later medical professionals.

"Today, although people still expect these kinds of death, medical advances and a growing dementia epidemic mean that we experience a prolonged death.

"Taking so long to die when you are so old that you become confused, unmanageable and unrecognisable to friends, makes the way we are likely to die uncertain.

"For governments and policy makers the best solution to this problem has been to build nursing homes - some people describe this as the final solution.

"When we interview nursing home residents through our research, they tell us that they feel they lead useless lives, are a burden to others, have no future, and suffer psychologically and physically.

"The care people receive in nursing homes continues to receive major criticism, not just in the UK but around the world.

"The most common concerns surround lack of attention to the cultural needs and cognitive status of the residents; their former lives are all but ignored.

"The fear of abandonment expressed by so many elderly people is frequently realised in full at many of these institutions.

"After two million years of dying characterised by well-patterned and well-understood partnerships with community, family and specialist health workers - the act of dying now appears to be disintegrating."

For Kellehear, it is no surprise that some people take control of the only component of their dying over which they have any measure of control - the timing of their death.

He believes that increasing numbers of elderly and terminally ill people will turn to suicide in order to take control and manage their own death.

"There are approximately one million suicides per year world wide, and the largest age-related grouping is for those over 80 years of age," said Kellehear.

"Old people intent on suicide seem very serious about their decision to die; they are less likely to give a warning, and are far more likely to complete a suicide than other ages. (50 per cent of over 65s who try to kill themselves through suicide succeed in doing so, compared to 25 per cent in younger age groups.)

"This is not about the well-publicised individuals who insist on their right to die, this is about ordinary older people who do not want to face disability, pain, cognitive impairment, and loss of bodily and social autonomy and dignity that old age can bring.

"When asked, respondents to a survey on why they might not want to live to 100 said that being a burden to others, losing the ability to be active and useful, losing the ability to think and reason clearly and the desire to avoid prolonged suffering, were the key reasons offered as to why finding the right timing for death was important."

Kellehear believes that governments and individuals need to tackle the issue of how we care for the dying before it becomes a major crisis.

"Whether it is introducing more liberal policies that enable people to better manage how they die, a closer examination of medical ethics, better training for nursing homes or support for people who care for elderly - something needs to happen," said Kellehear.

"We need to tackle the subject of dying head on. Talking about dying, let alone our own death, is not a popular theme for politicians or public debate, but there is no escape from the tragedy that will befall many of us when we die."



One In Five People Will Face A 'shameful' Death - Could It Be You?
五分之一的人会“不体面地”死去——会是你吗？
Article Date: 04 Apr 2007 - 1:00 PDT

Most people are unprepared for the shameful reality of how they could die, warns the author of a new book charting the social history of dying.
死亡的社会历史——这本新书的作者警告说：“大部分人不愿意面对关于如何死亡这个令人沮丧的事实”。
Although the majority of people imagine they will grow old and die in their sleep, surrounded by friends and family, one in five people will die what previous generations would consider a 'shameful' death - alone, ravaged by dementia and without dignity.
尽管大部分人想象他们将会变老并在睡眠中死去，有朋友和家人陪伴在周围，有五分之一的人将会像前辈们认为的那样“不体面地”死去——孤独，痴呆，没有尊严。

The deaths of more than half of the population will be 'managed' by medical professionals following serious injury or ill-health, with a small proportion dying suddenly, and often unexpectedly.
死亡人群中一多半人将在身患重伤或患病后经医学专家救治，一小部分人突然死亡，并常常是出人意料的。
The rapid increase of the shameful death is being fuelled by an ageing population and a lack of foresight over how to deal with the ultimate consequences of the medical advances which keep people alive for longer.由于人群的老化和缺乏如何处理使人寿命更长的医学进步的最终后果的先见之明，不体面死亡迅速增加。
"Most people think only fleetingly about how they will die, and usually it surrounds some romantic notion of dying in our sleep at home," said Allan Kellehear, Professor of Sociology at the University of Bath and author of the new book A social history of dying (please note - this is NOT an academic text). “大部分人对如何死亡的想法只是一瞬既逝，但我们通常对死亡会有罗曼蒂克的的想法，即在家里死于睡梦中”。巴思大学的社会学教授，Allan Kellehea说，她也是死亡的社会历史这本新书的作者。（请注意——这并不是学术论著）

"This notion couldn't be further from the truth; we are significantly more likely to die a lonely prolonged death in a nursing home or hospital, preceded by multiple organ failure, pneumonia or dementia. 这种想法不可能来源于现实，我们显然更愿意在发生多器官功能衰竭、肺炎或痴呆后，在疗养院或医院里单独地慢慢地死去。

"As we live longer, there is every chance that we will outlive those friends and family who would have traditionally seen us through our last years. It is also likely that we will have exhausted the financial means by which we would pay professionals to look after us instead.
我们活的时间越长，就会有机会让朋友和家人在我们最后的日子里习惯性地来探望我们。也有可能我们会在医学专家那里耗尽钱财，最终只有专家来照顾我们。
"Dying today is becoming increasingly tragic and antisocial.
在现在的社会，死亡正在迅速变成一件不幸的、与这个社会格格不入的事情。
"The way we die is important because it is the last act of life, and plays an important role in how our friends and relatives will remember us. 我们死亡的方式很重要，因为它是人生的最后一幕，对于我们的朋友和亲戚如何记住我们起着很重要的作用。，

"Some people spend years dying, and for many of the one in four of us who currently end our days in a nursing home, those last years can be like a living death.
一些人过了数年死亡，对于现在在疗养院中就结束我们生命的许多人中的四分之一的人而言，最后的几年就是活受罪。
"The way we care for our dying is a true reflection on how a society cares for its people; and it has to be said that the way we treat our dying in developed countries around the world is truly shocking." 我们计较死亡的方式就是这个社会如何对待人们的一个真实的反映；不得不说的是：在全世界的发达国家中我们对待死亡的方式真的令人震惊。

A social history of dying charts the experience of death from the remains of the early humans through to the experiences of people today. Kellehear has used on his own research on the topic and has drawn on human and clinical sciences literature of dying from around the world. 死亡的社会历史这本书绘图说明了死亡发生的历程，从早期人类的遗迹到今天人们的经历。在这个问题上，Kellehea用于他自己的研究，他绘制了来自全世界的人类和临床科学死亡文献的图表。
"The early humans mostly died of predation, but as soon as settlements sprang up, we started living longer but dying of the diseases that affect our farmed animals," said Kellehear.
早期的人类大多死于掠食，但是随着财物的出现，我们开始生存的时间更长。但是死于能够传染给我们所养殖的动物的疾病。

"From then on we see the emergence of two main kinds of death: the 'good' peasant death surrounded by friends and family and the 'well-managed' death overseen by shamans and later medical professionals.
从那以后，我们看到出现了两种主要类型的死亡：一种是寿终正寝的农民在朋友和家人的陪伴中死亡，另一种是在僧人和后来的医学专家的陪伴下文雅的死亡

"Today, although people still expect these kinds of death, medical advances and a growing dementia epidemic mean that we experience a prolonged death.
今天，尽管人们仍然期待着这些类型的死亡，随着医学的进步和痴呆患者的不断增多意味着我们要经历更加漫长的死亡过程。

"Taking so long to die when you are so old that you become confused, unmanageable and unrecognisable to friends, makes the way we are likely to die uncertain.
当你已经如此老迈，死亡要经历如此长的时间，你会变的很困惑，难以控制并且无法认出朋友们，这些使我们的死亡方式变的难以确定。

For governments and policy makers the best solution to this problem has been to build nursing homes - some people describe this as the final solution.
对于政府和政策的制定者而言，这一问题最好的解决方法就是建立疗养院——一些人认为这是最终解决方式。
"When we interview nursing home residents through our research, they tell us that they feel they lead useless lives, are a burden to others, have no future, and suffer psychologically and physically.
在研究中，我们采访了疗养院的居住者，居住者告诉我们：他们感觉自己的生命毫无意义，是别人的负担，没有未来，正在遭受心理和身体上的痛苦。

"The care people receive in nursing homes continues to receive major criticism, not just in the UK but around the world.
不仅在英国，甚至全世界的人都在不断指责疗养院中的看护者们。

"The most common concerns surround lack of attention to the cultural needs and cognitive status of the residents; their former lives are all but ignored.
通常关心最多的是对文化需求关注的缺乏和居住者的认知状态，从前的生活就是他们的全部，但是被忽略了。

"The fear of abandonment expressed by so many elderly people is frequently realised in full at many of these institutions.
很多老年人表达他们已经没有恐惧感，这一点在许多这类机构中都有充分的体现。

"After two million years of dying characterised by well-patterned and well-understood partnerships with community, family and specialist health workers - the act of dying now appears to be disintegrating." 在经历了两百万年之后，死亡的特点是待遇优厚，被人理解，与社区、家人和保健卫生工作者的友好合作——现在死亡一幕似乎已经瓦解

For Kellehear, it is no surprise that some people take control of the only component of their dying over which they have any measure of control - the timing of their death.
对于Kellehear而言，一些人只能控制他们死亡的一个要素，但是对于死亡的时间没有任何办法来控制。

He believes that increasing numbers of elderly and terminally ill people will turn to suicide in order to take control and manage their own death.
他相信随着老年人数量和最终患病人数的不断增多，这些人会选择自杀来控制和安排他们自己的死亡。
"There are approximately one million suicides per year world wide, and the largest age-related grouping is for those over 80 years of age," said Kellehear.
Kellehear说：“全世界每年大约有一百万人自杀，自杀人数最多的年龄组是那些超过80岁的老年人“。
"Old people intent on suicide seem very serious about their decision to die; they are less likely to give a warning, and are far more likely to complete a suicide than other ages. (50 per cent of over 65s who try to kill themselves through suicide succeed in doing so, compared to 25 per cent in younger age groups.)
老年人对于他们所选择的自杀的死亡方式似乎非常热切，他们并不想得到警告，他们比其他年龄组的人更加希望用自杀来结束自己的生命（约超过50%的65岁以上的人试图并成功的选择了自杀的死亡方式，而较年轻组人群只有25%的人愿意选择自杀方式。）

"This is not about the well-publicised individuals who insist on their right to die, this is about ordinary older people who do not want to face disability, pain, cognitive impairment, and loss of bodily and social autonomy and dignity that old age can bring.
这并不是那些坚持要求死亡权利的人们的广告宣传，而是那些普通的老年人不愿面对由于年老给他们带来的无能为力、痛苦和认知的损害，并同时失去肉体上和社会上的自治和尊严。

"When asked, respondents to a survey on why they might not want to live to 100 said that being a burden to others, losing the ability to be active and useful, losing the ability to think and reason clearly and the desire to avoid prolonged suffering, were the key reasons offered as to why finding the right timing for death was important."
在一项关于“为什么他们不想活到100岁”的调查报告中，回答者们提供的为何选择恰当的死亡时间非常重要的关键原因是：成为他人的负担，没有能力和用处，丧失准确思考和判断的能力，以及希望避免遭受更长时间的痛苦。

Kellehear believes that governments and individuals need to tackle the issue of how we care for the dying before it becomes a major crisis.
Kellehear相信政府和个人需要解决这个问题：那就是在死亡成为一个重要的危机之前如何来关注它。

"Whether it is introducing more liberal policies that enable people to better manage how they die, a closer examination of medical ethics, better training for nursing homes or support for people who care for elderly - something needs to happen," said Kellehear.
Kellehear说：无论是否应该介绍更多的自由政策来使人们更好的安排如何死亡，一项医学伦理学测试，更好的培训疗养院的看护者或者给那些照顾老年人的的人们以更多的支持——需要我们做一些事情了。

"We need to tackle the subject of dying head on. Talking about dying, let alone our own death, is not a popular theme for politicians or public debate, but there is no escape from the tragedy that will befall many of us when we die."
我们需要解决的首要问题就是死亡。谈到死亡，更不必说我们自己的死，对于政客或公共辩论而言，这并不是一个受欢迎的话题，但是当我们死亡的时候，我们中的许多人将不可避免的面临这一悲剧。


五分之一的人会“不体面地”死去——会是你吗？
文章日期：2007年4月4日 太平洋夏令时1：00
死亡的社会历史——这本新书的作者警告说：“大部分人不愿意面对关于如何死亡这个令人沮丧的事实”。尽管大部分人想象他们将会变老并在睡眠中死去，有朋友和家人陪伴在周围，有五分之一的人将会像前辈们认为的那样“不体面地”死去——孤独，痴呆，没有尊严。死亡人群中一多半人将在身患重伤或患病后经医学专家救治，一小部分人突然死亡，并常常是出人意料的。
由于人群的老化和缺乏如何处理使人寿命更长的医学进步的最终后果的先见之明，不体面死亡迅速增加。“大部分人对如何死亡的想法只是一瞬既逝，但我们通常对死亡会有罗曼蒂克的的想法，即在家里死于睡梦中”。巴思大学的社会学教授，Allan Kellehea说，她也是死亡的社会历史这本新书的作者。（请注意——这并不是学术论著）。这种想法不可能来源于现实，我们显然更愿意在发生多器官功能衰竭、肺炎或痴呆后，在疗养院或医院里单独地慢慢地死去。
我们活的时间越长，就会有机会让朋友和家人在我们最后的日子里习惯性地来探望我们。也有可能我们会在医学专家那里耗尽钱财，最终只有专家来照顾我们。在现在的社会，死亡正在迅速变成一件不幸的、与这个社会格格不入的事情。
我们死亡的方式很重要，因为它是人生的最后一幕，对于我们的朋友和亲戚如何记住我们起着很重要的作用。，一些人过了数年死亡，对于现在在疗养院中就结束我们生命的许多人中的四分之一的人而言，最后的几年就是活受罪。" 我们计较死亡的方式就是这个社会如何对待人们的一个真实的反映；不得不说的是：在全世界的发达国家中我们对待死亡的方式真的令人震惊。
死亡的社会历史这本书绘图说明了死亡发生的历程，从早期人类的遗迹到今天人们的经历。在这个问题上，Kellehea用于他自己的研究，他绘制了来自全世界的人类和临床科学死亡文献的图表。早期的人类大多死于掠食，但是随着财物的出现，我们开始生存的时间更长。但是死于能够传染给我们所养殖的动物的疾病。
从那以后，我们看到出现了两种主要类型的死亡：一种是寿终正寝的农民在朋友和家人的陪伴中死亡，另一种是在僧人和后来的医学专家的陪伴下文雅的死亡。今天，尽管人们仍然期待着这些类型的死亡，，随着医学的进步和痴呆患者的不断增多意味着我们要经历更加漫长的死亡过程。
当你已经如此老迈，死亡要经历如此长的时间，你会变的很困惑，难以控制并且无法认出朋友们，这些使我们的死亡方式变的难以确定。对于政府和政策的制定者而言，这一问题最好的解决方法就是建立疗养院——一些人认为这是最终解决方式。在研究中，我们采访了疗养院的居住者，居住者告诉我们：他们感觉自己的生命毫无意义，是别人的负担，没有未来，正在遭受心理和身体上的痛苦。
不仅在英国，甚至全世界的人都在不断指责疗养院中的看护者们。关心最多的是对文化需求关注的缺乏和居住者的认知状态，从前的生活就是他们的全部，但是被忽略了。很多老年人表达他们已经没有恐惧感，这一点在许多这类机构中都有充分的体现。
在经历了两百万年之后，死亡的特点是待遇优厚，被人理解，与社区、家人和保健卫生工作者的友好合作——现在死亡一幕似乎已经瓦解。对于Kellehear而言，一些人只能控制他们死亡的一个要素，但是对于死亡的时间没有任何办法来控制。他相信随着老年人数量和最终患病人数的不断增多，这些人会选择自杀来控制和安排他们自己的死亡。Kellehear说：“全世界每年大约有一百万人自杀，自杀人数最多的年龄组是那些超过80岁的老年人“老年人对于他们所选择的自杀的死亡方式似乎非常热切，他们并不想得到警告，他们比其他年龄组的人更加希望用自杀来结束自己的生命（约超过50%的65岁以上的人试图并成功的选择了自杀的死亡方式，而较年轻组人群只有25%的人愿意选择自杀方式。）
这并不是那些坚持要求死亡权利的人们的广告宣传，而是那些普通的老年人不愿面对由于年老给他们带来的无能为力、痛苦和认知的损害，并同时失去肉体上和社会上的自治和尊严。在一项关于“为什么他们不想活到100岁”的调查报告中，回答者们提供的为何选择恰当的死亡时间非常重要的关键原因是：成为他人的负担，没有能力和用处，丧失准确思考和判断的能力，以及希望避免遭受更长时间的痛苦。Kellehear相信政府和个人需要解决这个问题：那就是在死亡成为一个重要的危机之前如何来关注它。
Kellehear说：无论是否应该介绍更多的自由政策来使人们更好的安排如何死亡，一项医学伦理学测试，更好的培训疗养院的看护者或者给那些照顾老年人的的人们以更多的支持——需要我们做一些事情了。我们需要解决的首要问题就是死亡。谈到死亡，更不必说我们自己的死，对于政客或公共辩论而言，这并不是一个受欢迎的话题，但是当我们死亡的时候，我们中的许多人将不可避免的面临这一悲剧。