TEDxNewy
Peter Saul: Let's talk about dying
Piter Sol (Peter Saul): Hajde da pričamo o umiranju
Filmed:
Readability: 3.4
1,072,759 views
Po rečima dr Pitera Sola, mi nemamo kontrolu nad time da li ćemo umreti, ali zato možemo da utičemo na smrt. On nas poziva da jasno izrazimo svoje stavove što se obustavljanja lečenja tiče - i predlaže dva pitanja kojima se započinje ovakav razgovor. (Snimljeno na TEDxNewy.)
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. Full bio
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 thoughts, really,
0
578
2023
Predomišljao sam se
00:18
about whether I could talk about this
1
2601
2035
da li mogu da govorim o ovome
00:20
to such a vital and alive audience as you guys.
2
4636
3040
publici koja je ovako puna života, kao vi.
00:23
Then I remembered the quote from Gloria Steinem,
3
7676
2590
A onda sam se setio citata Glorije Stajnem
00:26
which goes,
4
10266
1639
koji kaže:
00:27
"The truth will set you free,
5
11905
1931
"Istina će vas osloboditi,
00:29
but first it will piss you off." (Laughter)
6
13836
3959
ali će vas prvo dobro naljutiti."
(Smeh)
(Smeh)
00:33
So -- (Laughter)
7
17795
2268
Tako da... (Smeh)
00:35
So with that in mind, I'm going to set about
8
20063
2124
Imajući ovo na umu,
00:38
trying to do those things here,
9
22187
1591
to ću vam pokazati
00:39
and talk about dying in the 21st century.
10
23778
1862
tako što ću govoriti o umiranju u 21. veku.
00:41
Now the first thing that will piss you off, undoubtedly,
11
25640
2400
Prva stvar koja će vas sigurno naljutiti,
00:43
is that all of us are, in fact, going to die
12
28040
2619
je da ćemo svi mi umreti
00:46
in the 21st century.
13
30659
1074
u 21. veku.
00:47
There will be no exceptions to that.
14
31733
2390
Bez izuzetaka.
00:50
There are, apparently, about one in eight of you
15
34123
2657
Sudeći po anketama,
otprilike jedan od osmoro vas
otprilike jedan od osmoro vas
00:52
who think you're immortal, on surveys, but --
16
36780
2524
misli da je besmrtan, ali...
00:55
(Laughter)
17
39304
2178
(Smeh)
00:57
Unfortunately, that isn't going to happen.
18
41482
4613
Nažalost, to ne ide tako.
01:01
While I give this talk, in the next 10 minutes,
19
46095
1653
Dok vam budem ovo govorio,
u sledećih 10 minuta,
u sledećih 10 minuta,
01:03
a hundred million of my cells will die,
20
47748
3496
100 miliona mojih ćelija će odumreti,
01:07
and over the course of today, 2,000 of my brain cells
21
51244
2594
a tokom današnjeg dana,
2000 mojih moždanih ćelija
2000 mojih moždanih ćelija
01:09
will die and never come back,
22
53838
2141
će nepovratno nestati,
01:11
so you could argue that the dying process
23
55979
2081
tako da bi se moglo reći
da proces umiranja
da proces umiranja
01:13
starts pretty early in the piece.
24
58060
2078
počinje prilično rano.
01:16
Anyway, the second thing I want to say about dying in the
25
60138
2114
U svakom slučaju, druga stvar
koju želim da kažem o umiranju
koju želim da kažem o umiranju
01:18
21st century, apart from it's going to happen to everybody,
26
62252
2365
u 21. veku, osim toga
da nas to sve očekuje,
da nas to sve očekuje,
01:20
is it's shaping up to be a bit of a train wreck
27
64617
2616
je da taj proces za većinu nas
01:23
for most of us,
28
67233
2345
liči na raspad sistema,
01:25
unless we do something to try and reclaim this process
29
69578
2969
osim ako uradimo nešto
što će ga preusmeriti
što će ga preusmeriti
01:28
from the rather inexorable trajectory that it's currently on.
30
72547
3717
sa njegove trenutne,
nezaustavljive putanje.
nezaustavljive putanje.
01:32
So there you go. That's the truth.
31
76264
1808
Tako da, to je istina.
01:33
No doubt that will piss you off, and now let's see
32
78072
1431
Ne sumnjam da će vas to naljutiti,
a sada hajde da vidimo
a sada hajde da vidimo
01:35
whether we can set you free. I don't promise anything.
33
79503
2976
da li može i da vas oslobodi.
Ništa ne obećavam.
Ništa ne obećavam.
01:38
Now, as you heard in the intro, I work in intensive care,
34
82479
2583
Kao što ste čuli u uvodnom govoru,
ja radim na intenzivnoj nezi
ja radim na intenzivnoj nezi
01:40
and I think I've kind of lived through the heyday
35
85062
3104
i mislim da sam na neki način
proživeo zlatno doba
proživeo zlatno doba
01:44
of intensive care. It's been a ride, man.
36
88166
2007
intenzivne nege.
Bila je to prilično luda vožnja.
Bila je to prilično luda vožnja.
01:46
This has been fantastic.
37
90173
1200
I bilo je fantastično.
01:47
We have machines that go ping.
38
91373
1155
Imamo svemoguće mašine.
01:48
There's many of them up there.
39
92528
2310
I to mnogo njih.
01:50
And we have some wizard technology which I think
40
94838
2744
I imamo nekakvu magičnu tehnologiju
za koju smatram
za koju smatram
01:53
has worked really well, and over the course of the time
41
97582
2512
da nas je dobro služila
01:55
I've worked in intensive care, the death rate
42
100094
2072
i od kada radim na intenzivnoj nezi,
stopa smrtnosti
stopa smrtnosti
01:58
for males in Australia has halved,
43
102166
2370
muškaraca u Australiji se upola smanjila,
02:00
and intensive care has had something to do with that.
44
104536
1619
a intenzivna nega imala je udela u tome.
02:02
Certainly, a lot of the technologies that we use
45
106155
2008
Definitivno, mnoge od tehnologija
koje koristimo
koje koristimo
02:04
have got something to do with that.
46
108163
2220
imale su udela u tome.
02:06
So we have had tremendous success, and we kind of
47
110383
2504
Tako da smo imali ogroman uspeh
i na neki način
i na neki način
02:08
got caught up in our own success quite a bit,
48
112887
2354
smo se zaneli tim uspehom
02:11
and we started using expressions like "lifesaving."
49
115241
3624
i počeli da koristimo izraze poput
"spasavanje života".
"spasavanje života".
02:14
I really apologize to everybody for doing that,
50
118865
2134
Izvinjavam se svima zvog toga,
02:16
because obviously, we don't.
51
120999
1230
jer mi to očigledno ne radimo.
02:18
What we do is prolong people's lives,
52
122229
2528
Ono što mi radimo, je produžavanje života,
02:20
and delay death,
53
124757
2101
odlaganje smrti
02:22
and redirect death, but we can't, strictly speaking,
54
126858
2845
i preusmeravanje smrti, ali ne možemo,
u pravom smislu,
u pravom smislu,
02:25
save lives on any sort of permanent basis.
55
129703
2855
trajno spasiti živote.
02:28
And what's really happened over the period of time
56
132558
1985
A ono što se stvarno desilo tokom mog rada
02:30
that I've been working in intensive care is that
57
134543
2639
na intenzivnoj nezi je da ljudi
02:33
the people whose lives we started saving back in the '70s,
58
137182
3570
čije živote smo počeli da spašavamo
u sedamdesetim,
u sedamdesetim,
02:36
'80s, and '90s, are now coming to die in the 21st century
59
140752
4478
osamdesetim i devedesetim godinama,
sada dolaze da umru u 21. veku
sada dolaze da umru u 21. veku
02:41
of diseases that we no longer have the answers to
60
145230
3600
zbog bolesti na koje više nemamo odgovore
02:44
in quite the way we did then.
61
148830
2510
onako kako smo ih imali pre.
02:47
So what's happening now is there's been a big shift
62
151340
1875
Ono što se trenutno dešava je velika promena
02:49
in the way that people die,
63
153215
1807
u načinu na koji ljudi umiru
02:50
and most of what they're dying of now isn't as amenable
64
155022
2271
i većina uzroka smrti više nije toliko rešiva
02:53
to what we can do as what it used to be like
65
157293
2826
kao što je to bila
02:56
when I was doing this in the '80s and '90s.
66
160119
3911
onda kada sam se ovim bavio
u osamdesetima i devedesetima.
u osamdesetima i devedesetima.
02:59
So we kind of got a bit caught up with this,
67
164030
2864
Dakle, malo nas je ovo sve zateklo
03:02
and we haven't really squared with you guys about
68
166894
3033
i nismo bili baš otvoreni
sa vama u vezi sa onim
sa vama u vezi sa onim
03:05
what's really happening now, and it's about time we did.
69
169927
4055
što se zapravo dešava trenutno.
Ali vreme je da se to promeni.
Ali vreme je da se to promeni.
03:09
I kind of woke up to this bit in the late '90s
70
173982
3391
Nekako su mi se otvorile oči
u kasnim devedesetima
u kasnim devedesetima
03:13
when I met this guy.
71
177373
2094
kada sam upoznao ovog čoveka.
03:15
This guy is called Jim, Jim Smith, and he looked like this.
72
179467
4357
Njegovo ime je Džim, Džim Smit,
i izgledao je ovako.
i izgledao je ovako.
03:19
I was called down to the ward to see him.
73
183824
2303
Pozvali su me na odeljenje da ga pogledam.
03:22
His is the little hand.
74
186127
2245
Njegova je ova manja ruka.
03:24
I was called down to the ward to see him
75
188372
1386
Dakle, lekar za grudne bolesti
03:25
by a respiratory physician.
76
189758
1094
pozvao me je da ga pogledam.
03:26
He said, "Look, there's a guy down here.
77
190852
2176
Rekao mi je:
"Slušaj, imamo jednog čoveka ovde.
"Slušaj, imamo jednog čoveka ovde.
03:28
He's got pneumonia,
78
193028
1600
Ima upalu pluća
03:30
and he looks like he needs intensive care.
79
194628
2505
i izgleda mi kao da mu je potrebna
intenzivna nega.
intenzivna nega.
03:33
His daughter's here and she wants everything possible
80
197133
2074
Njegova ćerka je ovde
i želi da uradimo sve
i želi da uradimo sve
03:35
to be done."
81
199207
2531
što je u našoj moći".
03:37
Which is a familiar phrase to us.
82
201738
2619
A ovo nam je veoma poznata rečenica.
03:40
So I go down to the ward and see Jim,
83
204357
1831
I ja odem do odeljenja
da pogledam Džima,
da pogledam Džima,
03:42
and his skin his translucent like this.
84
206188
1685
a njegova koža je providna,
kao što možete da vidite.
kao što možete da vidite.
03:43
You can see his bones through the skin.
85
207873
2250
Možete da mu vidite kosti kroz kožu.
03:46
He's very, very thin,
86
210123
1538
Veoma, veoma je mršav
03:47
and he is, indeed, very sick with pneumonia,
87
211661
3382
i zaista je u lošem stanju zbog upale pluća.
03:50
and he's too sick to talk to me,
88
215043
1481
I previše mu je loše da govori,
03:52
so I talk to his daughter Kathleen, and I say to her,
89
216524
5150
tako da uzmem da razgovaram
sa njegovom ćerkom Ketlin i pitam je:
sa njegovom ćerkom Ketlin i pitam je:
03:57
"Did you and Jim ever talk about
90
221674
2964
"Da li ste Džim i vi ikada razgovarali o tome
04:00
what you would want done
91
224638
1683
šta biste želeli da uradite
04:02
if he ended up in this kind of situation?"
92
226321
2014
kad bi on završio u ovakvoj sitaciji?"
04:04
And she looked at me and said, "No, of course not!"
93
228335
3729
A ona me je pogledala i rekla:
"Ne, naravno da nismo!"
"Ne, naravno da nismo!"
04:07
I thought, "Okay. Take this steady."
94
232064
5060
Pomislio sam:
"Okej. Hajdemo polako."
"Okej. Hajdemo polako."
04:13
And I got talking to her, and after a while, she said to me,
95
237124
2844
Porazgovarao sam s njom
i posle nekog vremena, rekla mi je:
i posle nekog vremena, rekla mi je:
04:15
"You know, we always thought there'd be time."
96
239968
3003
"Znate, uvek smo mislili
da će biti vremena za to."
da će biti vremena za to."
04:18
Jim was 94. (Laughter)
97
242971
3766
Džimu je tada bilo 94 godine. (Smeh)
04:22
And I realized that something wasn't happening here.
98
246737
2534
I shvatio sam da je nešto tu nedostajalo.
04:25
There wasn't this dialogue going on
99
249271
1324
Nije bilo tog razgovora
04:26
that I imagined was happening.
100
250595
2653
za koji sam mislio da se dešava.
04:29
So a group of us started doing survey work,
101
253248
3007
Tako da je nekolicina nas
počela da sprovodi istraživanja
počela da sprovodi istraživanja
04:32
and we looked at four and a half thousand nursing home
102
256255
2220
i pregledali smo 4,5 hiljade staračkih domova
04:34
residents in Newcastle, in the Newcastle area,
103
258475
3340
u Njukaslu i njegovoj okolini.
04:37
and discovered that only one in a hundred of them
104
261815
2947
Otkrili smo da samo jedan od sto njih
04:40
had a plan about what to do when their hearts stopped beating.
105
264762
3065
ima plan za trenutak kada srca tih ljudi
prestanu da kucaju.
prestanu da kucaju.
04:43
One in a hundred.
106
267827
1139
Jedan od sto.
04:44
And only one in 500 of them had plan about what to do
107
268966
3341
A samo jedan od petsto njih ima plan
04:48
if they became seriously ill.
108
272307
3097
ako se neko od njih ozbiljno razboli.
04:51
And I realized, of course, this dialogue
109
275404
2760
I shvatio sam, naravno, ovaj se razgovor
04:54
is definitely not occurring in the public at large.
110
278164
4636
uglavnom ne odvija u našem društvu.
04:58
Now, I work in acute care.
111
282800
1478
E sada, ja radim na akutnoj nezi.
05:00
This is John Hunter Hospital.
112
284278
2105
Radi se o bolnici Džon Hanter.
05:02
And I thought, surely, we do better than that.
113
286383
4001
I pomislio sam, sigurno možemo bolje od toga.
05:06
So a colleague of mine from nursing called Lisa Shaw and I
114
290384
2996
Zatim sam sa koleginicom
Lisom Šo, koja je negovateljica,
Lisom Šo, koja je negovateljica,
05:09
went through hundreds and hundreds of sets of notes
115
293380
2516
prošao kroz stotine i stotine papira
05:11
in the medical records department
116
295896
1273
u odeljenju medicinskih dosijea
05:13
looking at whether there was any sign at all
117
297169
2621
ne bismo li pronašli ikakvog traga
05:15
that anybody had had any conversation about
118
299790
2428
da je neko imao ikakav razgovor o tome
05:18
what might happen to them if the treatment they were
119
302218
1853
šta bi se moglo desiti sa njima,
ako bi terapija
ako bi terapija
05:19
receiving was unsuccessful to the point that they would die.
120
304071
3344
koju primaju bila neuspešna
i ako bi oni umrli.
i ako bi oni umrli.
05:23
And we didn't find a single record of any preference
121
307415
2941
I nismo našli nijedan dokaz o preferiranim
05:26
about goals, treatments or outcomes from any
122
310356
3844
ciljevima, terapiji ili ishodima ni u jednom
05:30
of the sets of notes initiated by a doctor or by a patient.
123
314200
4570
zapisu lekara ili pacijenta.
05:34
So we started to realize
124
318770
2717
Počeli smo da shvatamo
05:37
that we had a problem,
125
321487
2201
da imamo problem,
05:39
and the problem is more serious because of this.
126
323688
5023
a on je još ozbiljniji zbog ovoga.
(Važno je kako ćete umreti.)
(Važno je kako ćete umreti.)
05:44
What we know is that obviously we are all going to die,
127
328711
3302
Ono što znamo
je da ćemo zasigurno svi umreti,
je da ćemo zasigurno svi umreti,
05:47
but how we die is actually really important,
128
332013
2665
ali kako ćemo umreti
je zapravo veoma važno
je zapravo veoma važno
05:50
obviously not just to us, but also to how that
129
334678
3555
i to ne samo zbog nas,
nego i zbog toga kako će se to
nego i zbog toga kako će se to
05:54
features in the lives of all the people who live on afterwards.
130
338233
3134
odraziti na živote ljudi
koji nastavljaju da žive posle toga.
koji nastavljaju da žive posle toga.
05:57
How we die lives on in the minds of everybody
131
341367
2321
Način na koji umremo
ostaje u glavama svih
ostaje u glavama svih
05:59
who survives us, and
132
343688
3117
koji nas nadžive
06:02
the stress created in families by dying is enormous,
133
346805
3732
i stres koji zbog smrti
nastaje u porodici je ogroman.
nastaje u porodici je ogroman.
06:06
and in fact you get seven times as much stress by dying
134
350537
2686
Zapravo, taj stres je sedam puta veći
ako se umre
ako se umre
06:09
in intensive care as by dying just about anywhere else,
135
353223
2737
na intenzivnoj nezi nego ako se umre
bilo gde drugde.
bilo gde drugde.
06:11
so dying in intensive care is not your top option
136
355960
3078
Tako da, smrt na intenzivnoj nezi
ne bi bio vaš prvi izbor,
ne bi bio vaš prvi izbor,
06:14
if you've got a choice.
137
359038
2458
ako biste mogli da birate.
06:17
And, if that wasn't bad enough, of course,
138
361496
2169
A kao da ovo nije dovoljno loše,
06:19
all of this is rapidly progressing towards the fact that
139
363665
2648
sve to brzo napreduje prema činjenici da će
06:22
many of you, in fact, about one in 10 of you at this point,
140
366313
2352
mnogi od vas, oko jedan od deset vas,
06:24
will die in intensive care.
141
368665
1450
umreti na intenzivnoj nezi.
06:26
In the U.S., it's one in five.
142
370115
1334
U SAD, to je jedan od pet.
06:27
In Miami, it's three out of five people die in intensive care.
143
371449
3750
U Majamiju, tri od pet ljudi
umre na intenzivnoj nezi.
umre na intenzivnoj nezi.
06:31
So this is the sort of momentum
144
375199
2065
Dakle, trenutno
06:33
that we've got at the moment.
145
377264
2288
imamo porast u ovim brojevima.
06:35
The reason why this is all happening is due to this,
146
379552
2545
Razlog svega toga je ovo što vidite
06:37
and I do have to take you through what this is about.
147
382097
1302
i zaista moram da vam objasnim
značenje ovih grafikona.
značenje ovih grafikona.
06:39
These are the four ways to go.
148
383399
1965
Ovo su četiri načina na koje se umire.
06:41
So one of these will happen to all of us.
149
385364
2865
Dakle, jedan od ovih će se desiti svima nama.
06:44
The ones you may know most about are the ones
150
388229
2530
Oni koje možda najbolje poznajete su oni
06:46
that are becoming increasingly of historical interest:
151
390759
2846
koji sve više postaju od istorijskog značaja:
06:49
sudden death.
152
393605
1417
iznenadna smrt.
06:50
It's quite likely in an audience this size
153
395022
1445
Veoma je verovatno da se iz publike u ovom broju
06:52
this won't happen to anybody here.
154
396467
2551
ovakva smrt neće desiti nikome ovde.
06:54
Sudden death has become very rare.
155
399018
1730
Iznenadna smrt postala je veoma retka.
06:56
The death of Little Nell and Cordelia and all that sort of stuff
156
400748
2455
Smrti Male Nel i Kordelije [iz Kralja Lira]
i takve stvari
i takve stvari
06:59
just doesn't happen anymore.
157
403203
1673
jednostavno se više ne dešavaju.
07:00
The dying process of those with terminal illness
158
404876
2417
Proces umiranja poput onog
kod neizlečivih bolesti
kod neizlečivih bolesti
07:03
that we've just seen
159
407293
1032
koji smo upravo videli
07:04
occurs to younger people.
160
408325
1615
dešava se mlađim ljudima.
07:05
By the time you've reached 80, this is unlikely to happen to you.
161
409940
2850
Nakon što dosegnete osamdesetu,
malo je verovatno da će vam se to desiti.
malo je verovatno da će vam se to desiti.
07:08
Only one in 10 people who are over 80 will die of cancer.
162
412790
3415
Tek 1 od 10 ljudi koji imaju preko 80 godina,
umire od raka.
umire od raka.
07:12
The big growth industry are these.
163
416205
4835
U porastu su ove.
07:16
What you die of is increasing organ failure,
164
421040
3251
Ono od čega umirete je otkazivanje organa,
07:20
with your respiratory, cardiac, renal,
165
424291
2235
gde se vaša pluća, srce, bubrezi,
07:22
whatever organs packing up. Each of these
166
426526
1780
ili koji god organi, predaju.
Sve od ovoga
Sve od ovoga
07:24
would be an admission to an acute care hospital,
167
428306
2603
znači da biste bili primljeni
na akutnu negu u bolnici
na akutnu negu u bolnici
07:26
at the end of which, or at some point during which,
168
430909
1969
gde bi na kraju ili u toku nje
07:28
somebody says, enough is enough, and we stop.
169
432878
2176
neko rekao: "što je dosta, dosta je"
i mi stajemo.
i mi stajemo.
07:30
And this one's the biggest growth industry of all,
170
435054
2568
A ova ovde je u najvećem porastu od svih
07:33
and at least six out of 10 of the people in this room
171
437622
2575
i barem 6 od 10 ljudi u ovoj prostoriji
07:36
will die in this form, which is
172
440197
2562
umreće ovako, a to je
07:38
the dwindling of capacity
173
442759
3894
smanjenje kapaciteta
07:42
with increasing frailty,
174
446653
2319
sa porastom slabosti.
07:44
and frailty's an inevitable part of aging,
175
448972
2250
Slabost je neizbežan deo starenja,
07:47
and increasing frailty is in fact the main thing
176
451222
2553
a porast slabosti je zapravo glavni razlog
07:49
that people die of now,
177
453775
1049
smrti danas.
07:50
and the last few years, or the last year of your life
178
454824
2128
Poslednjih nekoliko godina
ili poslednju godinu svog života,
ili poslednju godinu svog života,
07:52
is spent with a great deal of disability, unfortunately.
179
456952
4015
nažalost, ćete provesti,
u velikoj meri, nemoćni.
u velikoj meri, nemoćni.
07:56
Enjoying it so far? (Laughs)
180
460967
3384
Uživamo li zasad? (Smeje se)
08:00
(Laughter)
181
464351
3153
(Smeh)
08:03
Sorry, I just feel such a, I feel such a Cassandra here.
182
467504
3428
Izvinite, osećam se
kao neka zloslutna proročica.
kao neka zloslutna proročica.
08:06
(Laughter)
183
470932
5158
(Smeh)
08:11
What can I say that's positive? What's positive is
184
476090
1059
Ono što je pozitivno je
08:13
that this is happening at very great age, now.
185
477149
2415
da se to sada dešava
u veoma kasnim godinama.
u veoma kasnim godinama.
08:15
We are all, most of us, living to reach this point.
186
479564
2745
Većina nas živi da bi dostigla ovu tačku.
08:18
You know, historically, we didn't do that.
187
482309
1888
Znate, u prošlosti, to nismo mogli.
08:20
This is what happens to you
188
484197
1469
To je ono što vam se desi
08:21
when you live to be a great age,
189
485666
2523
kada doživite te kasne godine,
08:24
and unfortunately, increasing longevity does mean
190
488189
1889
a, nažalost, povećanje dugovečnosti znači
08:25
more old age, not more youth.
191
490078
1927
dužu starost, ne dužu mladost.
08:27
I'm sorry to say that. (Laughter)
192
492005
6093
Žao mi je što to moram da vam kažem.
(Smeh)
(Smeh)
08:33
What we did, anyway, look, what we did,
193
498098
1797
Ono što smo uradili je da
08:35
we didn't just take this lying down
194
499895
1527
nismo samo sedeli skrštenih ruku
08:37
at John Hunter Hospital and elsewhere.
195
501422
1502
u bolnici Džnon Hanter ili negde drugde.
08:38
We've started a whole series of projects
196
502924
1622
Započeli smo čitav niz projekata
08:40
to try and look about whether we could, in fact, involve
197
504546
2996
kako bismo saznali da li možemo mnogo više
08:43
people much more in the way that things happen to them.
198
507542
3494
da uključimo ljude u ono što će im se desiti.
08:46
But we realized, of course, that we are dealing
199
511036
1232
Ali smo, naravno, shvatili da imamo posla
08:48
with cultural issues,
200
512268
2344
sa kulturološkim problemima.
08:50
and this is, I love this Klimt painting,
201
514612
1859
A ovo je, obožavam ovu Klimtovu sliku,
08:52
because the more you look at it, the more you kind of get
202
516471
2205
jer što je duže gledate, to bolje shvatate
08:54
the whole issue that's going on here,
203
518676
2019
ceo taj problem koji se odvija
08:56
which is clearly the separation of death from the living,
204
520695
3518
a to je naravno odvajanje smrti od života,
09:00
and the fear — Like, if you actually look,
205
524213
1880
i strah. Na primer, ako se zaista zadubite
09:01
there's one woman there
206
526093
1175
videćete ovu ženu ovde
09:03
who has her eyes open.
207
527268
1919
kojoj su otvorene oči.
09:05
She's the one he's looking at,
208
529187
1685
Ona je ta koju on gleda.
09:06
and [she's] the one he's coming for. Can you see that?
209
530872
3228
Po nju je došao. Vidite li to?
09:10
She looks terrified.
210
534100
1526
Ona izgleda prestravljeno.
09:11
It's an amazing picture.
211
535626
1693
Neverovatna slika.
09:13
Anyway, we had a major cultural issue.
212
537319
2221
U svakom slučaju, imali smo
ogroman kulturološki problem.
ogroman kulturološki problem.
09:15
Clearly, people didn't want us to talk about death,
213
539540
1984
Jasno je da ljudi nisu želeli
da pričamo o smrti
da pričamo o smrti
09:17
or, we thought that.
214
541524
1495
ili smo mi bar tako mislili.
09:18
So with loads of funding from the Federal Government
215
543019
1947
I tako smo sa ogromnom
finansijskom podrškom savezne vlade
finansijskom podrškom savezne vlade
09:20
and the local Health Service, we introduced a thing
216
544966
1420
i lokalne zdravstvene službe,
u bolnici Džon Hanter
u bolnici Džon Hanter
09:22
at John Hunter called Respecting Patient Choices.
217
546386
2898
predstavili nešto što se zove
Poštovanje izbora pacijenta.
Poštovanje izbora pacijenta.
09:25
We trained hundreds of people to go to the wards
218
549284
2849
Obučili smo stotine ljudi
da idu po odeljenjima
da idu po odeljenjima
09:28
and talk to people about the fact that they would die,
219
552133
3143
i pričaju sa ljudima
o činjenici da će umreti
o činjenici da će umreti
09:31
and what would they prefer under those circumstances.
220
555276
2286
i šta bi voleli da se uradi u tom slučaju.
09:33
They loved it. The families and the patients, they loved it.
221
557562
3519
I svidelo im se. I porodicama i pacijetima
se izuzetno svidelo.
se izuzetno svidelo.
09:36
Ninety-eight percent of people really thought
222
561081
2460
98 procenata ljudi je stvarno smatralo
09:39
this just should have been normal practice,
223
563541
1454
da to treba da bude
uobičajena praksa
uobičajena praksa
09:40
and that this is how things should work.
224
564995
2383
i da bi tako stvari trebalo da funkcionišu.
09:43
And when they expressed wishes,
225
567378
1938
I kada su izneli svoje želje
09:45
all of those wishes came true, as it were.
226
569316
1973
sve te želje su se ostvarile.
09:47
We were able to make that happen for them.
227
571289
1980
Mogli smo to da im omogućimo.
09:49
But then, when the funding ran out,
228
573269
2250
Ali onda, kada se finansijska pomoć potrošila
09:51
we went back to look six months later,
229
575519
2085
vratili smo se da vidimo 6 meseci kasnije
09:53
and everybody had stopped again,
230
577604
2267
i svi su prestali sa tim.
09:55
and nobody was having these conversations anymore.
231
579871
3193
Niko više nije vodio ove razgovore.
09:58
So that was really kind of heartbreaking for us,
232
583064
2053
To nas je prilično pogodilo,
10:01
because we thought this was going to really take off.
233
585117
2717
jer smo mislili
da će stvarno postati popularno.
da će stvarno postati popularno.
10:03
The cultural issue had reasserted itself.
234
587834
3971
Kulturološki problem se ponovo vratio.
10:07
So here's the pitch:
235
591805
1155
Dakle, šta je zaključak:
10:08
I think it's important that we don't just get on this freeway
236
592960
4086
važno je da se ne zaputimo
ovim autoputem
ovim autoputem
10:12
to ICU without thinking hard about whether or not
237
597046
2499
koji vodi ka intenzivnoj nezi,
a da pre toga dobro ne razmislimo
a da pre toga dobro ne razmislimo
10:15
that's where we all want to end up,
238
599545
1793
da li uopšte želimo tamo da završimo.
10:17
particularly as we become older and increasingly frail
239
601338
2136
Posebno pošto postanemo
sve stariji i slabiji
sve stariji i slabiji
10:19
and ICU has less and less and less to offer us.
240
603474
3654
i intenzivna nega ima sve manje
da nam ponudi.
da nam ponudi.
10:23
There has to be a little side road
241
607128
2330
Mora da postoji malo skretanje
10:25
off there for people who don't want to go on that track.
242
609458
4475
za ljude koji ne žele da idu tim putem.
10:29
And I have one small idea,
243
613933
2636
A ja imam jednu malu
10:32
and one big idea about what could happen.
244
616569
4449
i jednu veliku ideju
o tome šta bi se moglo desiti.
o tome šta bi se moglo desiti.
10:36
And this is the small idea.
245
621018
1061
A ovo je mala ideja.
10:37
The small idea is, let's all of us
246
622079
2781
Ona predlaže da se svi
10:40
engage more with this in the way that Jason has illustrated.
247
624860
3936
više uključimo u ovo na način
na koji je Džejson prikazao.
na koji je Džejson prikazao.
10:44
Why can't we have these kinds of conversations
248
628796
2053
Zašto ne možemo na ovaj način
da razgovaramo
da razgovaramo
10:46
with our own elders
249
630849
1321
sa starijima iz sopstvene okoline
10:48
and people who might be approaching this?
250
632170
2790
i sa ljudima koji se tome bliže?
10:50
There are a couple of things you can do.
251
634960
1834
Postoji nekoliko stvari
koje možete da uradite.
koje možete da uradite.
10:52
One of them is, you can,
252
636794
2131
Jedna od njih je da samo pitate
10:54
just ask this simple question. This question never fails.
253
638925
2914
ovo prosto pitanje.
Ono nikad ne zakaže.
Ono nikad ne zakaže.
10:57
"In the event that you became too sick to speak for yourself,
254
641839
3755
"U slučaju da postanete previše bolesni
da biste mogli da
da biste mogli da
11:01
who would you like to speak for you?"
255
645594
2933
govorite za sebe,
koga biste voleli da govori umesto vas?"
koga biste voleli da govori umesto vas?"
11:04
That's a really important question to ask people,
256
648527
1914
To je veoma važno pitanje
11:06
because giving people the control over who that is
257
650441
2023
jer dati ljudima odluku o toj osobi
11:08
produces an amazing outcome.
258
652464
3308
dovodi do neverovatnih rezultata.
11:11
The second thing you can say is,
259
655772
1146
Druga stvar koju možete da pitate je:
11:12
"Have you spoken to that person
260
656918
1498
"Da li ste razgovarali sa tom osobom
11:14
about the things that are important to you
261
658416
1920
o onome što je vama važno, kako bismo
11:16
so that we've got a better idea of what it is we can do?"
262
660336
4154
imali bolju ideju o tome
šta mi možemo da uradimo?"
šta mi možemo da uradimo?"
11:20
So that's the little idea.
263
664490
2522
Dakle, to je ta mala ideja.
11:22
The big idea, I think, is more political.
264
667012
1494
Mislim da je velika ideja više stvar politike.
11:24
I think we have to get onto this.
265
668506
1951
Mislim da moramo da se posvetimo ovome.
11:26
I suggested we should have Occupy Death.
266
670457
3062
Predložio sam nekakav protest za smrt.
11:29
(Laughter)
267
673519
2785
(Smeh)
11:32
My wife said, "Yeah, right, sit-ins in the mortuary.
268
676304
2570
Moja žena je rekla:
"Da, baš, skupljaćemo se u mrtvačnici.
"Da, baš, skupljaćemo se u mrtvačnici.
11:34
Yeah, yeah. Sure." (Laughter)
269
678874
2579
Da, da. SIgurno."
(Smeh)
(Smeh)
11:37
So that one didn't really run,
270
681453
1865
Tako da mi to baš nije uspelo,
11:39
but I was very struck by this.
271
683318
1670
ali bio sam dosta pogođen time.
11:40
Now, I'm an aging hippie.
272
684988
1713
Dobro, ja sam ostareli hipik.
11:42
I don't know, I don't think I look like that anymore, but
273
686701
2497
Ne znam,
mislim da ne izgledam tako više,
mislim da ne izgledam tako više,
11:45
I had, two of my kids were born at home in the '80s
274
689198
2500
ali dvoje moje dece rođeno je
kod kuće u osamdesetima
kod kuće u osamdesetima
11:47
when home birth was a big thing, and we baby boomers
275
691698
3468
kad je kućni porođaj bio popularan,
a mi, deo Bebi-bum generacije
a mi, deo Bebi-bum generacije
11:51
are used to taking charge of the situation,
276
695166
2696
navikli smo da preuzimamo kontrolu
nad situacijom,
nad situacijom,
11:53
so if you just replace all these words of birth,
277
697862
3398
tako da, ako samo zamenite
svuda gde piše "porođaj",
svuda gde piše "porođaj",
11:57
I like "Peace, Love, Natural Death" as an option.
278
701260
3081
meni se sviđa opcija
"Mir, ljubav, prirodna smrt".
"Mir, ljubav, prirodna smrt".
12:00
I do think we have to get political
279
704341
1516
Mislim da ne moramo da govorimo
u političkom smislu
u političkom smislu
12:01
and start to reclaim this process from
280
705857
2598
i da počnemo da premeštamo ovaj proces
12:04
the medicalized model in which it's going.
281
708455
1967
iz onog medicinskog modela
u kome se nalazi.
u kome se nalazi.
12:06
Now, listen, that sounds like a pitch for euthanasia.
282
710422
2040
Ali slušajte, to zvuči
kao da zagovaram eutanaziju.
kao da zagovaram eutanaziju.
12:08
I want to make it absolutely crystal clear to you all,
283
712462
2192
Želim da svima bude apsolutno kristalno jasno
12:10
I hate euthanasia. I think it's a sideshow.
284
714654
2664
da ja mrzim eutanaziju.
Mislim da je to sporedna stvar.
Mislim da je to sporedna stvar.
12:13
I don't think euthanasia matters.
285
717318
2187
Mislim da eutanazija nije bitna.
12:15
I actually think that,
286
719505
2151
Zaista mislim
12:17
in places like Oregon,
287
721656
2549
da na mestima poput Oregona
12:20
where you can have physician-assisted suicide,
288
724205
3472
gde je moguće izvršiti samoubistvo
uz pomoć lekara,
uz pomoć lekara,
12:23
you take a poisonous dose of stuff,
289
727677
2217
gde uzmete otrovnu dozu nečega,
12:25
only half a percent of people ever do that.
290
729894
1876
samo pola procenta ljudi se odluči na to.
12:27
I'm more interested in what happens to the 99.5 percent
291
731770
2706
Mene više zanima šta se dešava
sa 99,5 procenata
sa 99,5 procenata
12:30
of people who don't want to do that.
292
734476
1756
ljudi koji to ne žele.
12:32
I think most people don't want to be dead,
293
736232
2334
Mislim da većina ljudi ne želi da umre,
12:34
but I do think most people want to have some control
294
738566
2097
ali zato mislim da većina ljudi
želi da ima nekakvu kontrolu
želi da ima nekakvu kontrolu
12:36
over how their dying process proceeds.
295
740663
2742
nad svojim procesom umiranja.
12:39
So I'm an opponent of euthanasia,
296
743405
1140
Tako da sam ja protivnik eutanazije,
12:40
but I do think we have to give people back some control.
297
744545
2653
ali mislim da moramo
da damo ljudima neku kontrolu.
da damo ljudima neku kontrolu.
12:43
It deprives euthanasia of its oxygen supply.
298
747198
3473
Time bismo eutanaziji oduzeli zalihu kiseonika.
12:46
I think we should be looking at stopping
299
750671
1352
Mislim da treba da težimo zaustavljanju
12:47
the want for euthanasia,
300
752023
1039
želje za eutanazijom,
12:48
not for making it illegal or legal or worrying about it at all.
301
753062
4695
a ne tome da ona bude ilegalna ili legalna
ili da brinemo uopšte o tome.
ili da brinemo uopšte o tome.
12:53
This is a quote from Dame Cicely Saunders,
302
757757
3576
Ovo je citat gospođe Siseli Sonders,
12:57
whom I met when I was a medical student.
303
761333
1369
koju sam upoznao kao student medicine.
12:58
She founded the hospice movement.
304
762702
2879
Ona je osnovala pokret domova za nemoćne.
13:01
And she said, "You matter because you are,
305
765581
2191
I ona je rekla: "Značajan si jer postojiš,
13:03
and you matter to the last moment of your life."
306
767772
2522
i značajan si do poslednjeg trenutka
svog života".
svog života".
13:06
And I firmly believe that
307
770294
2257
I ja čvrsto verujem da je to
13:08
that's the message that we have to carry forward.
308
772551
3086
poruka koju moramo dalje da prenosimo.
13:11
Thank you. (Applause)
309
775637
3019
Hvala vam.
(Aplauz)
(Aplauz)
ABOUT THE SPEAKER
Peter Saul - Doctor, intensive care specialistOver 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.
Peter Saul | Speaker | TED.com