ABOUT THE SPEAKER
Peter Saul - Doctor, intensive care specialist
Over the past 35 years Peter Saul has been intimately involved in the dying process for over 4,000 patients. He is passionate about improving the ways we die.

Why you should listen

Dr. Peter Saul is a Senior Intensive Care specialist in the adult and pediatric ICU at John Hunter Hospital, and Director of Intensive Care at Newcastle Private Hospital in Australia.  After spending time as the Head of Discipline for Medical Ethics at Newcastle University, he is now a leading adviser to the State and Federal health departments.

More profile about the speaker
Peter Saul | Speaker | TED.com
TEDxNewy

Peter Saul: Let's talk about dying

彼得 索尔(Peter Saul):让我们来谈谈死亡

Filmed:
1,072,759 views

我们无法控制将要到来的死亡,但正如彼得索尔博士(Peter Saul)所言,我们可以”占领死亡“。他号召我们弄清我们在选择临终关怀时的意愿, 并且提出了两个可以开始这种谈话的问题。(TEDxNewy拍摄)
- Doctor, intensive care specialist
Over the past 35 years Peter Saul has been intimately involved in the dying process for over 4,000 patients. He is passionate about improving the ways we die. Full bio

Double-click the English transcript below to play the video.

00:16
Look, I had second第二 thoughts思念, really,
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说实话,我犹豫过
00:18
about whether是否 I could talk about this
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到底应不应该
00:20
to such这样 a vital重要 and alive audience听众 as you guys.
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对你们一群如此有活力的观众讲这个题目。
00:23
Then I remembered记得 the quote引用 from Gloria格洛丽亚 Steinem斯泰纳姆,
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但我又想起了Gloria Steinem的一句话
00:26
which哪一个 goes,
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她是这样说的
00:27
"The truth真相 will set you free自由,
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“真相会给你自由,
00:29
but first it will piss小便 you off." (Laughter笑声)
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但它会先令你难受”
00:33
So -- (Laughter笑声)
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所以呢……(笑声)
00:35
So with that in mind心神, I'm going to set about
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所以谨记着这一点,我要开始
00:38
trying to do those things here,
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试图来谈谈这些事
00:39
and talk about dying垂死 in the 21stST century世纪.
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聊一聊21世纪的死亡。
00:41
Now the first thing that will piss小便 you off, undoubtedly无疑,
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首先,第一件会令你们十分不爽的,毫无疑问的,
00:43
is that all of us are, in fact事实, going to die
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就是我们所有人,事实上,都将在
00:46
in the 21stST century世纪.
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21世纪死去。
00:47
There will be no exceptions例外 to that.
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这不会有例外吧!
00:50
There are, apparently显然地, about one in eight of you
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可是根据调查,我们当中每8个人就会有1个
00:52
who think you're immortal不朽, on surveys调查, but --
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觉得自己可以长生不老,但是……
00:55
(Laughter笑声)
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(笑声)
00:57
Unfortunately不幸, that isn't going to happen发生.
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不幸的是,长生不老是不可能的。
01:01
While I give this talk, in the next下一个 10 minutes分钟,
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在接下来的这10分钟内,就在我做这个演讲的同时,
01:03
a hundred million百万 of my cells细胞 will die,
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我身体里的一亿个细胞将死去,
01:07
and over the course课程 of today今天, 2,000 of my brain cells细胞
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今天,我的2000个脑细胞会死去
01:09
will die and never come back,
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而且永远不会回来。
01:11
so you could argue争论 that the dying垂死 process处理
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所以可以说,死亡的过程
01:13
starts启动 pretty漂亮 early in the piece.
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其实在这类的日常小事中就开始了。
01:16
Anyway无论如何, the second第二 thing I want to say about dying垂死 in the
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无论如何,我想说的关于死在21世纪的第二件事是,
01:18
21stST century世纪, apart距离 from it's going to happen发生 to everybody每个人,
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除了这件事会发生在每个人的身上以外,
01:20
is it's shaping成型 up to be a bit of a train培养 wreck破坏
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它对大部分人来说,就是一列好好的火车
01:23
for most of us,
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最终是怎么走向撞车和成为一个残骸的过程。
01:25
unless除非 we do something to try and reclaim回收 this process处理
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除非我们做点什么,把这列火车
01:28
from the rather inexorable残酷 trajectory弹道 that it's currently目前 on.
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从它现在正向着的死亡方面前进的轨道上拉回来。
01:32
So there you go. That's the truth真相.
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这就是我要告诉你的真相。
01:33
No doubt怀疑 that will piss小便 you off, and now let's see
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毫无疑问,这会让你非常不爽,但现在我们来看看
01:35
whether是否 we can set you free自由. I don't promise诺言 anything.
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可不可以让你获得自由并重生。但我不能向你保证什么。
01:38
Now, as you heard听说 in the intro介绍, I work in intensive集约 care关心,
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正如你们在介绍中听到的一样,我在ICU (重症监护治疗病房)工作,
01:40
and I think I've kind of lived生活 through通过 the heyday极盛
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而且我想我经历过ICU的黄金时期。
01:44
of intensive集约 care关心. It's been a ride, man.
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那就像坐过山车一样,
01:46
This has been fantastic奇妙.
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那真的一直都很棒。
01:47
We have machines that go ping.
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我们有很先进的设备。
01:48
There's many许多 of them up there.
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这照片上就有很多啊。
01:50
And we have some wizard巫师 technology技术 which哪一个 I think
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我们有一些魔术般的技术,
01:53
has worked工作 really well, and over the course课程 of the time
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我觉得一直以来都很好用。
01:55
I've worked工作 in intensive集约 care关心, the death死亡 rate
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在我在ICU工作的时间里,
01:58
for males男性 in Australia澳大利亚 has halved减半,
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澳大利亚的男性死亡率减少了一半,
02:00
and intensive集约 care关心 has had something to do with that.
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这跟ICU特护是有关系的。
02:02
Certainly当然, a lot of the technologies技术 that we use
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当然,这跟我们采用的许多技术
02:04
have got something to do with that.
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也有很大的关系。
02:06
So we have had tremendous巨大 success成功, and we kind of
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所以我们取得过巨大的成功,
02:08
got caught抓住 up in our own拥有 success成功 quite相当 a bit,
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而我们有点被自己的成功冲昏了头脑,
02:11
and we started开始 using运用 expressions表达式 like "lifesaving救生."
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所以,我们开始用一些像是“挽救生命”之类的词形容自己
02:14
I really apologize道歉 to everybody每个人 for doing that,
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为此我真的要对所有人表示歉意,
02:16
because obviously明显, we don't.
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因为,很明显,我们并不能救命。
02:18
What we do is prolong延长 people's人们 lives生活,
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我们能做的是延长人们的生命,
02:20
and delay延迟 death死亡,
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让死亡迟一点到来,
02:22
and redirect重定向 death死亡, but we can't, strictly严格 speaking请讲,
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让死亡的过程改变一点点,但是严格来说,
02:25
save保存 lives生活 on any sort分类 of permanent常驻 basis基础.
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从任何永久性的角度看,我们并不能拯救病人的生命。
02:28
And what's really happened发生 over the period of time
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而从我在ICU这些年的工作经验来看,
02:30
that I've been working加工 in intensive集约 care关心 is that
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事实的真相是,
02:33
the people whose谁的 lives生活 we started开始 saving保存 back in the '70s,
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我们在70年代,80年代,
02:36
'80s, and '90s, are now coming未来 to die in the 21stST century世纪
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90年代所救过来的人,现在慢慢开始在21世纪逝去
02:41
of diseases疾病 that we no longer have the answers答案 to
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——死于我们当时没法治愈
02:44
in quite相当 the way we did then.
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现在也一样没法的治愈的疾病。
02:47
So what's happening事件 now is there's been a big shift转移
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而最大的不同点是,
02:49
in the way that people die,
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人们死亡的方式发生了巨大的转变。
02:50
and most of what they're dying垂死 of now isn't as amenable适合
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而大部分让人们致死的疾病
02:53
to what we can do as what it used to be like
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已经和我们当年
02:56
when I was doing this in the '80s and '90s.
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在80年代、90年代处理的方法有了很大的不同了。
02:59
So we kind of got a bit caught抓住 up with this,
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所以我们也有点困惑
03:02
and we haven't没有 really squared平方 with you guys about
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而我们也没有机会和大家分享一下
03:05
what's really happening事件 now, and it's about time we did.
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如今ICU里都在发生什么。现在就让我们来看一下。
03:09
I kind of woke醒来 up to this bit in the late晚了 '90s
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我是在90年代后期才思考这个问题的,
03:13
when I met会见 this guy.
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当时我遇到了这个人。
03:15
This guy is called Jim吉姆, Jim吉姆 Smith工匠, and he looked看着 like this.
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他叫做Jim Smith,他当时的样子是这样的。
03:19
I was called down to the ward病房 to see him.
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我被叫到病房去看他。
03:22
His is the little hand.
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他的小手可以说是骨瘦如柴。
03:24
I was called down to the ward病房 to see him
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一名呼吸内科医生
03:25
by a respiratory呼吸 physician医师.
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将我叫到他的诊室。
03:26
He said, "Look, there's a guy down here.
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他对我说:“那有个病人”
03:28
He's got pneumonia肺炎,
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他得的是肺炎,
03:30
and he looks容貌 like he needs需求 intensive集约 care关心.
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看样子他需要入你们的ICU病房。
03:33
His daughter's女儿的 here and she wants everything possible可能
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他的女儿在这,
03:35
to be doneDONE."
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她希望你们能尽一切办法……
03:37
Which哪一个 is a familiar phrase短语 to us.
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这是我们常听到的一句话。
03:40
So I go down to the ward病房 and see Jim吉姆,
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所以,我去病房去看Jim Smith.
03:42
and his skin皮肤 his translucent半透明 like this.
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他的皮肤半透明成了这个样子。
03:43
You can see his bones骨头 through通过 the skin皮肤.
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透过他的皮肤,你们以看到他的骨头。
03:46
He's very, very thin,
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他可是说是瘦骨嶙峋。
03:47
and he is, indeed确实, very sick生病 with pneumonia肺炎,
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他的肺炎已是相当严重了
03:50
and he's too sick生病 to talk to me,
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病得连和我们讲话的力气都没有了
03:52
so I talk to his daughter女儿 Kathleen凯瑟琳, and I say to her,
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所以,我问他的女儿Kathleen:
03:57
"Did you and Jim吉姆 ever talk about
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"你有没有和他谈过"
04:00
what you would want doneDONE
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你会怎么处理这个事,
04:02
if he ended结束 up in this kind of situation情况?"
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如果他到了这种地步?
04:04
And she looked看着 at me and said, "No, of course课程 not!"
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她看了看我,然后说:”没有,当然没有“
04:07
I thought, "Okay. Take this steady稳定."
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好吧,我当时想,慢慢做她的工作吧。
04:13
And I got talking to her, and after a while, she said to me,
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我和她谈了很久,然后,她对我说:
04:15
"You know, we always thought there'd这红色 be time."
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你知道的,我们也知道,迟早会有那一天的。
04:18
Jim吉姆 was 94. (Laughter笑声)
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Jim 当时已经94岁了。(笑声)
04:22
And I realized实现 that something wasn't happening事件 here.
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这件事让我觉得,我们可以为这类病人做些事。
04:25
There wasn't this dialogue对话 going on
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要不是有这件事
04:26
that I imagined想象 was happening事件.
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我也想象不到我们会不会去做这件事。
04:29
So a group of us started开始 doing survey调查 work,
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所以,我们有一个小组开始做一些调查工作,
04:32
and we looked看着 at four and a half thousand nursing看护 home
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我们走访了
04:34
residents居民 in Newcastle新城堡, in the Newcastle新城堡 area,
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Newcastle地区的4500个在养老院生活的老人,
04:37
and discovered发现 that only one in a hundred of them
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我们发现,他们当中只有1%的人
04:40
had a plan计划 about what to do when their hearts心中 stopped停止 beating跳动.
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对他们生理死亡后的事有计划。
04:43
One in a hundred.
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仅仅1%。
04:44
And only one in 500 of them had plan计划 about what to do
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只有500分之1的老人
04:48
if they became成为 seriously认真地 ill生病.
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会对他们病重时有应对计划。
04:51
And I realized实现, of course课程, this dialogue对话
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这个对话使我意识到,
04:54
is definitely无疑 not occurring发生 in the public上市 at large.
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我们生活中的很多人肯定也会对我们的身后事没有计划的。
04:58
Now, I work in acute急性 care关心.
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现在,我在ICU里工作。
05:00
This is John约翰 Hunter猎人 Hospital醫院.
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我的医院叫“John Hunter”医院。
05:02
And I thought, surely一定, we do better than that.
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而过去我一直认为,我们做得比较好。
05:06
So a colleague同事 of mine from nursing看护 called Lisa丽莎 Shaw and I
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所以,我和我的同事Lisa Shaw,她来自养老院,
05:09
went through通过 hundreds数以百计 and hundreds数以百计 of sets of notes笔记
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我们一起在医疗档案室
05:11
in the medical records记录 department
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翻看了成千上万本病历,
05:13
looking at whether是否 there was any sign标志 at all
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我们想确认是否有
05:15
that anybody任何人 had had any conversation会话 about
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任何人曾经
05:18
what might威力 happen发生 to them if the treatment治疗 they were
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就如果他们的治疗失败
05:19
receiving接收 was unsuccessful不成功 to the point that they would die.
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而导致他们死亡而作出任何安排的谈话。
05:23
And we didn't find a single record记录 of any preference偏爱
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可是,我们找不到关于他们的自我选择,
05:26
about goals目标, treatments治疗 or outcomes结果 from any
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目标、治疗或者最终结果这方面的东西
05:30
of the sets of notes笔记 initiated启动 by a doctor医生 or by a patient患者.
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医生记录或病人自己写的都没有。
05:34
So we started开始 to realize实现
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我这才意识到
05:37
that we had a problem问题,
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我们出了问题,
05:39
and the problem问题 is more serious严重 because of this.
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而正因为这一点,这个问题变得更严重。
05:44
What we know is that obviously明显 we are all going to die,
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我们大家都知道的是很明显,我们都会死去,
05:47
but how we die is actually其实 really important重要,
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但我们以何种方式死去更重要,
05:50
obviously明显 not just to us, but also to how that
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很明显,这不仅对我们重要,
05:54
features特征 in the lives生活 of all the people who live生活 on afterwards之后.
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这对那些活着的人也很重要。
05:57
How we die lives生活 on in the minds头脑 of everybody每个人
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其实我们会怎样死去,
05:59
who survives生存 us, and
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这在抢救我们的人的心中是心里有数的,
06:02
the stress强调 created创建 in families家庭 by dying垂死 is enormous巨大,
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而死亡给一个家庭带来的压力是巨大的,
06:06
and in fact事实 you get seven times as much stress强调 by dying垂死
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事实上,死在ICU所带来的压力
06:09
in intensive集约 care关心 as by dying垂死 just about anywhere随地 else其他,
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是死在其它地方所带来的压力的7倍,
06:11
so dying垂死 in intensive集约 care关心 is not your top最佳 option选项
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所以,选择在ICU结束自己的生活并不是一个明智的决定
06:14
if you've got a choice选择.
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——如果你有得选择的话。
06:17
And, if that wasn't bad enough足够, of course课程,
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如果这还不算太糟糕的话,当然
06:19
all of this is rapidly急速 progressing进展 towards the fact事实 that
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我们很快可以看到另一个数据
06:22
many许多 of you, in fact事实, about one in 10 of you at this point,
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很多人,事实上,大约10个人当中就有1个
06:24
will die in intensive集约 care关心.
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会死在ICU中。
06:26
In the U.S., it's one in five.
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而在美国,这个数字是每5个人当中有1个。
06:27
In Miami迈阿密, it's three out of five people die in intensive集约 care关心.
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在迈阿密,这个数字是每5个人当中有3个。
06:31
So this is the sort分类 of momentum动量
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这就是我们目前所看到的
06:33
that we've我们已经 got at the moment时刻.
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发展势头。
06:35
The reason原因 why this is all happening事件 is due应有 to this,
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事情会变成这个样子主要是因为这个。
06:37
and I do have to take you through通过 what this is about.
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而我要带领大家去一起探讨一下其原因。
06:39
These are the four ways方法 to go.
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21世纪主要有四种死亡形式。
06:41
So one of these will happen发生 to all of us.
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我们所有人都会以其中的一种形式死去。
06:44
The ones那些 you may可能 know most about are the ones那些
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人们最熟知的死亡方式
06:46
that are becoming变得 increasingly日益 of historical历史的 interest利益:
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也是越来越引起我们关注的一种死亡方式
06:49
sudden突然 death死亡.
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——猝死。
06:50
It's quite相当 likely容易 in an audience听众 this size尺寸
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在我们这样的观众群中,
06:52
this won't惯于 happen发生 to anybody任何人 here.
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可能不会有这种死亡。
06:54
Sudden突然 death死亡 has become成为 very rare罕见.
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猝死现在已经很少见了。
06:56
The death死亡 of Little Nell内尔 and Cordelia科黛拉 and all that sort分类 of stuff东东
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像 Little Nell 或 Condelia 那样猝死的案例
06:59
just doesn't happen发生 anymore.
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现在已经很少了。
07:00
The dying垂死 process处理 of those with terminal终奌站 illness疾病
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现在因为患绝症而死亡的病人
07:03
that we've我们已经 just seen看到
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正如我们刚才看到的一样,
07:04
occurs发生 to younger更年轻 people.
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在年轻人中的发病率越来越高了。
07:05
By the time you've reached到达 80, this is unlikely不会 to happen发生 to you.
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到你80岁,这也不可能发生在你身上。
07:08
Only one in 10 people who are over 80 will die of cancer癌症.
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现在80岁年龄层中只有10%的人死于癌症。
07:12
The big growth发展 industry行业 are these.
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而造成死亡最多的因素主要在以下几个方面。
07:16
What you die of is increasing增加 organ器官 failure失败,
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越来越多的人死于器官功能衰竭
07:20
with your respiratory呼吸, cardiac心脏的, renal,
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如呼吸和心、肾功能衰竭等等。
07:22
whatever随你 organs器官 packing填料 up. Each of these
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不管以上那个器官出了问题
07:24
would be an admission入场 to an acute急性 care关心 hospital醫院,
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病人都要紧急送院治疗,
07:26
at the end结束 of which哪一个, or at some point during which哪一个,
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到最后,或者在治疗过程中的某一时间上
07:28
somebody says, enough足够 is enough足够, and we stop.
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直到有人对我们说不用治了,我们才放弃。
07:30
And this one's那些 the biggest最大 growth发展 industry行业 of all,
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这是我们见得最多的案例,
07:33
and at least最小 six out of 10 of the people in this room房间
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每10个在这里听演讲的人中就会有6个
07:36
will die in this form形成, which哪一个 is
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将会以这种方式结束我们的一生,
07:38
the dwindling日益减少 of capacity容量
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这是因为功能的缺失
07:42
with increasing增加 frailty脆弱,
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造成的生命的脆弱,
07:44
and frailty's脆弱的 an inevitable必然 part部分 of aging老化,
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而脆弱是老龄化不可避免的进程,
07:47
and increasing增加 frailty脆弱 is in fact事实 the main主要 thing
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而脆弱事实上就是
07:49
that people die of now,
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现代人死亡的主要原因,
07:50
and the last few少数 years年份, or the last year of your life
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你生命的最后一年或几年时间
07:52
is spent花费 with a great deal合同 of disability失能, unfortunately不幸.
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你都会在能力缺失中度过,这太不幸了。
07:56
Enjoying享受 it so far? (Laughs)
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你们还承受得住么?(笑声)
08:00
(Laughter笑声)
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(笑声)
08:03
Sorry, I just feel such这样 a, I feel such这样 a Cassandra卡桑德拉 here.
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对不起,我怎么成了一个卡珊德拉式的预言家了呢。
08:06
(Laughter笑声)
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(笑声)
08:11
What can I say that's positive? What's positive is
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但积极的一面是
08:13
that this is happening事件 at very great age年龄, now.
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这只发生在老年人当中。
08:15
We are all, most of us, living活的 to reach达到 this point.
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我们大家也都会经历这一时期的。
08:18
You know, historically历史, we didn't do that.
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要知道,以住要活到这么长的人不多的。
08:20
This is what happens发生 to you
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这种死亡方式
08:21
when you live生活 to be a great age年龄,
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只会发生在那些高龄人身上,
08:24
and unfortunately不幸, increasing增加 longevity长寿 does mean
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不幸的是,寿命的延长
08:25
more old age年龄, not more youth青年.
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延长的不是青春,而是老年的时光。
08:27
I'm sorry to say that. (Laughter笑声)
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很遗憾这样说。(笑声)
08:33
What we did, anyway无论如何, look, what we did,
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不管怎么说,我们所做的
08:35
we didn't just take this lying说谎 down
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我们并不仅仅指那些
08:37
at John约翰 Hunter猎人 Hospital醫院 and elsewhere别处.
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在John Hunter 医院逝去的人或在其它地方死去的人。
08:38
We've我们已经 started开始 a whole整个 series系列 of projects项目
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我们已经开始一系列的项目
08:40
to try and look about whether是否 we could, in fact事实, involve涉及
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尝试去了解我们能否让更多的人
08:43
people much more in the way that things happen发生 to them.
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参与到那些可能发生到他们身上去的事。
08:46
But we realized实现, of course课程, that we are dealing交易
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然而,我们当然意识到
08:48
with cultural文化 issues问题,
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我们要应对一些文化层面的问题,
08:50
and this is, I love this Klimt克里姆特 painting绘画,
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我喜欢这张克里姆特的画,
08:52
because the more you look at it, the more you kind of get
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这是因为,你越看它,
08:54
the whole整个 issue问题 that's going on here,
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你越能了解发生在这里的一切,
08:56
which哪一个 is clearly明确地 the separation分割 of death死亡 from the living活的,
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而这明显是一种死与生,
09:00
and the fear恐惧 — Like, if you actually其实 look,
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和恐惧的分隔。比如说,如果你仔细看的话,
09:01
there's one woman女人 there
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你会发现有个女人
09:03
who has her eyes眼睛 open打开.
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她的眼睛是睁着的。
09:05
She's the one he's looking at,
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他在看着她,
09:06
and [she's] the one he's coming未来 for. Can you see that?
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他就是冲着她来的。你们看到了吗?
09:10
She looks容貌 terrified.
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她看起来很惊恐。
09:11
It's an amazing惊人 picture图片.
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这是一幅很不错的画。
09:13
Anyway无论如何, we had a major重大的 cultural文化 issue问题.
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另外,我们还有一个主要的文化层面的问题。
09:15
Clearly明确地, people didn't want us to talk about death死亡,
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显而易见,人们并不希望我们和他们谈论死亡,
09:17
or, we thought that.
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或者,我们自己如此认为。
09:18
So with loads负载 of funding资金 from the Federal联邦 Government政府
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所以,在联邦政府和地方卫生部门资金的支持下
09:20
and the local本地 Health健康 Service服务, we introduced介绍 a thing
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我们在John Hunter医院引入了
09:22
at John约翰 Hunter猎人 called Respecting关于 Patient患者 Choices选择.
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一个名为“尊重病人的选择”的项目
09:25
We trained熟练 hundreds数以百计 of people to go to the wards病房
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我们培训了成百上千的工作人员,
09:28
and talk to people about the fact事实 that they would die,
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派他到病房去告诉别人他们大限将至
09:31
and what would they prefer比较喜欢 under those circumstances情况.
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然后问他们有什么打算。
09:33
They loved喜爱 it. The families家庭 and the patients耐心, they loved喜爱 it.
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此举受到病人和家属的欢迎。
09:36
Ninety-eight九八 percent百分 of people really thought
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98%的人真的认为
09:39
this just should have been normal正常 practice实践,
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这应该成为一种常态化的做法,
09:40
and that this is how things should work.
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同时,这也是顺应自然的做法。
09:43
And when they expressed表达 wishes祝福,
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而当这些病人表达他们的意愿的时候,
09:45
all of those wishes祝福 came来了 true真正, as it were.
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所有这些意愿都可以实现。
09:47
We were able能够 to make that happen发生 for them.
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我们可以帮他们实行他们的意愿。
09:49
But then, when the funding资金 ran out,
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然而,当这笔资金用完之后中,
09:51
we went back to look six months个月 later后来,
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六个月后我们再来评估这一项目,
09:53
and everybody每个人 had stopped停止 again,
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这一做法又被停止了。
09:55
and nobody没有人 was having these conversations对话 anymore.
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也没有人去进行这方面的谈话了。
09:58
So that was really kind of heartbreaking令人心碎 for us,
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这是一种很令我们心酸的结局,
10:01
because we thought this was going to really take off.
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因为我们一直以为,这会成为一种常态化的东西。
10:03
The cultural文化 issue问题 had reasserted重申 itself本身.
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文化问题又一次得到了体现。
10:07
So here's这里的 the pitch沥青:
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这就是问题所在。
10:08
I think it's important重要 that we don't just get on this freeway高速公路
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我认为,在我们决定走上去ICU这条路时,
10:12
to ICUICU without thinking思维 hard about whether是否 or not
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我们真的要想
10:15
that's where we all want to end结束 up,
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我们是否真的想死在ICU里,
10:17
particularly尤其 as we become成为 older旧的 and increasingly日益 frail脆弱
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这点在我们老态龙钟和变得脆弱不堪时尤其重要,
10:19
and ICUICU has less and less and less to offer提供 us.
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这时,ICU能为我们做的事情是少之又少的。
10:23
There has to be a little side road
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如果不去ICU,肯定还有其它的选择的
10:25
off there for people who don't want to go on that track跟踪.
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前提是——你不想死在ICU里。
10:29
And I have one small idea理念,
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而对于可能发生的事,我有一个“小”主意
10:32
and one big idea理念 about what could happen发生.
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我一个“大”主意
10:36
And this is the small idea理念.
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我的小主意是:
10:37
The small idea理念 is, let's all of us
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让我们所有人
10:40
engage从事 more with this in the way that Jason贾森 has illustrated插图.
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更多地象Jason所描述的那样。
10:44
Why can't we have these kinds of conversations对话
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我们为什么就不能和Jason一样
10:46
with our own拥有 elders长老
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和我们的长辈
10:48
and people who might威力 be approaching接近 this?
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或者那些正在慢慢变老的人和Jason一样谈一下这个问题呢?
10:50
There are a couple一对 of things you can do.
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你可以为此做一些事情。
10:52
One of them is, you can,
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其中一个是,
10:54
just ask this simple简单 question. This question never fails失败.
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你只需问一个简单的问题。这是一个很有用的问题。
10:57
"In the event事件 that you became成为 too sick生病 to speak说话 for yourself你自己,
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“万一你病得不能讲话了,
11:01
who would you like to speak说话 for you?"
255
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你想让谁代你表达你的心声呢?”
11:04
That's a really important重要 question to ask people,
256
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1914
这真是一个非常重要的问题,
11:06
because giving people the control控制 over who that is
257
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2023
这是因为,给予谁这个权利
11:08
produces产生 an amazing惊人 outcome结果.
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会给你带来不同的结局。
11:11
The second第二 thing you can say is,
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你可以说的第二个事情是,
11:12
"Have you spoken to that person
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“你和哪个人谈过了
11:14
about the things that are important重要 to you
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你认为对你来说是很重要的事吗
11:16
so that we've我们已经 got a better idea理念 of what it is we can do?"
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那样我们就比较清楚我们能为你做些什么。
11:20
So that's the little idea理念.
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这就是我的“小”主意。
11:22
The big idea理念, I think, is more political政治.
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我的大主意,我认为更实用。
11:24
I think we have to get onto this.
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我认为,我们必须做好一件事。
11:26
I suggested建议 we should have Occupy占据 Death死亡.
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我建议搞一个“占领死亡”运动(Occupy Death)
11:29
(Laughter笑声)
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(笑声)
11:32
My wife妻子 said, "Yeah, right, sit-ins静坐 in the mortuary停尸间.
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我妻子对我说,“对,对,到太平间去静坐”
11:34
Yeah, yeah. Sure." (Laughter笑声)
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对,应该的。 (笑声)
11:37
So that one didn't really run,
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1865
所以,这个行不通,
11:39
but I was very struck来袭 by this.
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但我还是受到一些打击的。
11:40
Now, I'm an aging老化 hippie嬉皮士.
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现在,我是一个老嬉皮士。
11:42
I don't know, I don't think I look like that anymore, but
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我不知道,我并不认为我还象一个嬉皮士,但是
11:45
I had, two of my kids孩子 were born天生 at home in the '80s
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在90年代,我的两个小孩都是在家里生产的
11:47
when home birth分娩 was a big thing, and we baby宝宝 boomers
275
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3468
那时,在家生小孩是件大事,而我们这帮婴儿潮年代出生的人
11:51
are used to taking服用 charge收费 of the situation情况,
276
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已经习惯了处理这些事,
11:53
so if you just replace更换 all these words of birth分娩,
277
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3398
所以,如果你要替换掉这些关于生产的字,
11:57
I like "Peace和平, Love, Natural自然 Death死亡" as an option选项.
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我会选择“和平、爱和自然死亡”
12:00
I do think we have to get political政治
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我真的认为,我们必须得面对现实
12:01
and start开始 to reclaim回收 this process处理 from
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并且重申这一进程
12:04
the medicalized用医学方法 model模型 in which哪一个 it's going.
281
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1967
从我们现行的医疗化模型中解放出来
12:06
Now, listen, that sounds声音 like a pitch沥青 for euthanasia安乐死.
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听走来,好像我又在鼓吹安乐死。
12:08
I want to make it absolutely绝对 crystal水晶 clear明确 to you all,
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我想向各位澄清一下
12:10
I hate讨厌 euthanasia安乐死. I think it's a sideshow杂耍.
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我讨厌安乐死。我认为那是一个次要的问题。
12:13
I don't think euthanasia安乐死 matters事项.
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我不认为安乐死会有什么好处
12:15
I actually其实 think that,
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2151
事实上, 我认为,
12:17
in places地方 like Oregon俄勒冈,
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2549
在象Oregon这类地方,
12:20
where you can have physician-assisted医生协助 suicide自杀,
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你可以寻求到一些在医生的辅助下的自杀方式,
12:23
you take a poisonous有毒 dose剂量 of stuff东东,
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你可以吃点毒药之类的东西,
12:25
only half a percent百分 of people ever do that.
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可只有0.5%的人做过这样的蠢事。
12:27
I'm more interested有兴趣 in what happens发生 to the 99.5 percent百分
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2706
其实,我对其它的99.5%的
12:30
of people who don't want to do that.
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不想通过服毒而死去的人感兴趣。
12:32
I think most people don't want to be dead,
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我想,大多数人都不想死,
12:34
but I do think most people want to have some control控制
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但我认为,大多数人都想能够控制
12:36
over how their dying垂死 process处理 proceeds收益.
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自己死亡的过程。
12:39
So I'm an opponent对手 of euthanasia安乐死,
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1140
所以,我反对安乐死,
12:40
but I do think we have to give people back some control控制.
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但我又认为,我们应该给病重的人一些自己控制权。
12:43
It deprives剥夺 euthanasia安乐死 of its oxygen supply供应.
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这能够让安乐死失去理由。
12:46
I think we should be looking at stopping停止
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我认为,我们应该去尝试了解病人
12:47
the want for euthanasia安乐死,
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想要安乐死背后的原因,
12:48
not for making制造 it illegal非法 or legal法律 or worrying令人担忧 about it at all.
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而不只是让它合法代或非法,或者毫不关心。
12:53
This is a quote引用 from Dame贵妇人 Cicely西塞莉 Saunders桑德斯,
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这是Dame Cicely Saunders的一句话,
12:57
whom I met会见 when I was a medical student学生.
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我还是一个医学院学生的时候遇过她
12:58
She founded成立 the hospice临终关怀 movement运动.
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她创立了护理所运动。
13:01
And she said, "You matter because you are,
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她说,“你就是你,你是重要的,
13:03
and you matter to the last moment时刻 of your life."
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直到你生命的最后一刻。“
13:06
And I firmly牢牢 believe that
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我坚定地相信
13:08
that's the message信息 that we have to carry携带 forward前锋.
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这是我们应该继续前行的旨意
13:11
Thank you. (Applause掌声)
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谢谢(掌声)
Translated by Bi Chen
Reviewed by Psycho Decoder

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ABOUT THE SPEAKER
Peter Saul - Doctor, intensive care specialist
Over the past 35 years Peter Saul has been intimately involved in the dying process for over 4,000 patients. He is passionate about improving the ways we die.

Why you should listen

Dr. Peter Saul is a Senior Intensive Care specialist in the adult and pediatric ICU at John Hunter Hospital, and Director of Intensive Care at Newcastle Private Hospital in Australia.  After spending time as the Head of Discipline for Medical Ethics at Newcastle University, he is now a leading adviser to the State and Federal health departments.

More profile about the speaker
Peter Saul | Speaker | TED.com