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

Peter Saul:死亡二三事

Filmed:
1,072,759 views

對於死亡,我們無能為力,但依 Dr. Peter Saul 所言,我們能“佔領死 (星)”。他闡釋並呼籲我們接受安寧照顧的概念 ---- 還提供了兩個問題,使我們更容易進行討論。(於 TEDNewy 拍攝)
- 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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各位,我本來還在猶豫
00:18
about whether是否 I could talk about this
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該不該跟你們這些
00:20
to such這樣 a vital重要 and alive audience聽眾 as you guys.
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充滿活力與精力的觀眾討論這件事
00:23
Then I remembered記得 the quote引用 from Gloria格洛麗亞 Steinem斯泰納姆,
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然後我想到Gloria Steinem說過的話
00:26
which哪一個 goes,
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她說:
00:27
"The truth真相 will set you free自由,
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"真相能讓你自由,
00:29
but first it will piss小便 you off." (Laughter笑聲)
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但是你會先被惹毛。"(笑聲)
00:33
So -- (Laughter笑聲)
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所以...(笑聲)
00:35
So with that in mind心神, I'm going to set about
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這句話我銘記在心,所以等一下我要做的
00:38
trying to do those things here,
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就是遵循這個忠告,
00:39
and talk about dying垂死 in the 21stST century世紀.
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然後談論21世紀對死亡的看法
00:41
Now the first thing that will piss小便 you off, undoubtedly無疑,
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無庸置疑,現在第一個讓你們不爽的事情就是
00:43
is that all of us are, in fact事實, going to die
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即使已到了21世紀
00:46
in the 21stST century世紀.
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我們所有人還是難逃一死
00:47
There will be no exceptions例外 to that.
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沒有人能例外
00:50
There are, apparently顯然地, about one in eight of you
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根據統計,你們之中大概每八個就有一個
00:52
who think you're immortal不朽, on surveys調查, but --
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認為自己是不死之身,但是...
00:55
(Laughter笑聲)
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(笑聲)
00:57
Unfortunately不幸, that isn't going to happen發生.
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很抱歉,沒這種事
01:01
While I give this talk, in the next下一個 10 minutes分鐘,
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接下來我在演講的這十分鐘內
01:03
a hundred million百萬 of my cells細胞 will die,
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我體內的細胞會死掉一億個
01:07
and over the course課程 of today今天, 2,000 of my brain cells細胞
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今天一整天下來,我的腦細胞
01:09
will die and never come back,
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會死掉兩千個,而且不會再復活
01:11
so you could argue爭論 that the dying垂死 process處理
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所以我們可以這樣說,死亡的過程
01:13
starts啟動 pretty漂亮 early in the piece.
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很早就開始了
01:16
Anyway無論如何, the second第二 thing I want to say about dying垂死 in the
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總之,關於21世紀對死亡的看法
01:18
21stST century世紀, apart距離 from it's going to happen發生 to everybody每個人,
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我要說的第二件事是,
除了所有人都難逃一死之外
01:20
is it's shaping成型 up to be a bit of a train培養 wreck破壞
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就是死亡對於我們大多數的人而言,有點像是
01:23
for most of us,
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火車事故
01:25
unless除非 we do something to try and reclaim回收 this process處理
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除非我們試圖改變現況而有所作為
01:28
from the rather inexorable殘酷 trajectory彈道 that it's currently目前 on.
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讓火車離開這條直直朝災難而去的軌道
01:32
So there you go. That's the truth真相.
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你們看。這就是真相
01:33
No doubt懷疑 that will piss小便 you off, and now let's see
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難怪你會被惹毛,接下來我們來看看
01:35
whether是否 we can set you free自由. I don't promise諾言 anything.
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你能不能獲得自由。這我可不敢保證
01:38
Now, as you heard聽說 in the intro介紹, I work in intensive集約 care關心,
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好,你們剛剛在簡介裡聽到了,我在加護病房工作
01:40
and I think I've kind of lived生活 through通過 the heyday極盛
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而且我經歷過加護病房的全盛時期
01:44
of intensive集約 care關心. It's been a ride, man.
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說真的,那很不得了
01:46
This has been fantastic奇妙.
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那種感覺很棒
01:47
We have machines that go ping.
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我們有鏗鏘作響的機器
01:48
There's many許多 of them up there.
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照片裡面就有一堆
01:50
And we have some wizard巫師 technology技術 which哪一個 I think
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我們也有傑出的技術,我認為
01:53
has worked工作 really well, and over the course課程 of the time
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那些技術的效果很好,我在加護病房
01:55
I've worked工作 in intensive集約 care關心, the death死亡 rate
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工作的那段時間,澳洲男性的
01:58
for males男性 in Australia澳大利亞 has halved減半,
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死亡率降了一半
02:00
and intensive集約 care關心 has had something to do with that.
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這有些要歸功於加護病房
02:02
Certainly當然, a lot of the technologies技術 that we use
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當然,很多我們採用的科技
02:04
have got something to do with that.
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都有助於降低死亡率
02:06
So we have had tremendous巨大 success成功, and we kind of
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也因此我們的成就相當可觀
02:08
got caught抓住 up in our own擁有 success成功 quite相當 a bit,
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而且我們也沉浸在成功的喜悅之中
02:11
and we started開始 using運用 expressions表達式 like "lifesaving救生."
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然後我們開始使用 “拯救生命” 這種字眼
02:14
I really apologize道歉 to everybody每個人 for doing that,
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為此,我必須跟各位道歉
02:16
because obviously明顯, we don't.
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因為我們根本沒有 “拯救生命”
02:18
What we do is prolong延長 people's人們 lives生活,
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我們只是延長人們的壽命
02:20
and delay延遲 death死亡,
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延遲死亡的到來
02:22
and redirect重定向 death死亡, but we can't, strictly嚴格 speaking請講,
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避開死亡這個結局,但嚴格說來,我們辦不到
02:25
save保存 lives生活 on any sort分類 of permanent常駐 basis基礎.
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我們無法違背這些恆久不變的原則,拯救生命
02:28
And what's really happened發生 over the period of time
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而事實上這段期間發生的事
02:30
that I've been working加工 in intensive集約 care關心 is that
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也就是我在加護病房工作的時候
02:33
the people whose誰的 lives生活 we started開始 saving保存 back in the '70s,
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當初我們在70、80和90年代所拯救的性命
02:36
'80s, and '90s, are now coming未來 to die in the 21stST century世紀
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到了21世紀都一一離開人世了
02:41
of diseases疾病 that we no longer have the answers答案 to
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一些疾病讓我們束手無策
02:44
in quite相當 the way we did then.
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無法像以前一樣醫治他們
02:47
So what's happening事件 now is there's been a big shift轉移
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所以現況是,人們的死亡方式
02:49
in the way that people die,
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產生了極大的轉變
02:50
and most of what they're dying垂死 of now isn't as amenable適合
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80、90年代時,大多數病患的死因
02:53
to what we can do as what it used to be like
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我們都還能掌控
02:56
when I was doing this in the '80s and '90s.
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但是現在我們卻束手無策
02:59
So we kind of got a bit caught抓住 up with this,
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可以說我們陷入困境了
03:02
and we haven't沒有 really squared平方 with you guys about
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而且對於現在發生的事
03:05
what's really happening事件 now, and it's about time we did.
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我們之間還沒取得共識,不過現在是好時機
03:09
I kind of woke醒來 up to this bit in the late晚了 '90s
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90年代末期,我遇到了這個人
03:13
when I met會見 this guy.
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他讓我有了這種想法
03:15
This guy is called Jim吉姆, Jim吉姆 Smith工匠, and he looked看著 like this.
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他叫Jim,Jim Smith,這是他的照片
03:19
I was called down to the ward病房 to see him.
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我被叫去病房看他
03:22
His is the little hand.
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這隻小手是他的
03:24
I was called down to the ward病房 to see him
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是一名呼吸科醫生
03:25
by a respiratory呼吸 physician醫師.
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叫我去病房看他的
03:26
He said, "Look, there's a guy down here.
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他說:“聽我說,樓下有個
03:28
He's got pneumonia肺炎,
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得了肺炎的人
03:30
and he looks容貌 like he needs需求 intensive集約 care關心.
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看起來應該需要特別的監護
03:33
His daughter's女兒的 here and she wants everything possible可能
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他的女兒在這裡,她希望我們
03:35
to be doneDONE."
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盡全力照顧他”
03:37
Which哪一個 is a familiar phrase短語 to us.
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這句話聽起來很耳熟
03:40
So I go down to the ward病房 and see Jim吉姆,
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所以我到樓下的病房看Jim
03:42
and his skin皮膚 his translucent半透明 like this.
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他的皮膚像這樣,是半透明的
03:43
You can see his bones骨頭 through通過 the skin皮膚.
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你可以看到皮膚底下的骨頭
03:46
He's very, very thin,
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他非常非常瘦
03:47
and he is, indeed確實, very sick生病 with pneumonia肺炎,
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當然,他也被肺炎折磨得很慘
03:50
and he's too sick生病 to talk to me,
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虛弱到連跟我說話的力氣都沒有
03:52
so I talk to his daughter女兒 Kathleen凱瑟琳, and I say to her,
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所以我跟她的女兒Kathleen說,我對她說
03:57
"Did you and Jim吉姆 ever talk about
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“妳和Jim有沒有聊過
04:00
what you would want doneDONE
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如果他就這樣過世
04:02
if he ended結束 up in this kind of situation情況?"
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妳會怎麼處裡嗎?”
04:04
And she looked看著 at me and said, "No, of course課程 not!"
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然後她看著我,她說:“沒有,當然沒有!”
04:07
I thought, "Okay. Take this steady穩定."
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我心想:“好吧。別刺激她。”
04:13
And I got talking to her, and after a while, she said to me,
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然後我跟她聊了這件事,過了一會兒,她跟我說
04:15
"You know, we always thought there'd這紅色 be time."
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“你知道嗎,我們都一直以為還有時間。”
04:18
Jim吉姆 was 94. (Laughter笑聲)
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Jim已經94歲了。(笑聲)
04:22
And I realized實現 that something wasn't happening事件 here.
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然後我才發現,有些事情並沒有實現
04:25
There wasn't this dialogue對話 going on
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如果我想像的事情實現了
04:26
that I imagined想像 was happening事件.
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我們就不會有這種對話了
04:29
So a group of us started開始 doing survey調查 work,
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所以我們的團隊開始著手考察
04:32
and we looked看著 at four and a half thousand nursing看護 home
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然後我們仔細研究了4500間的看護之家
04:34
residents居民 in Newcastle新城堡, in the Newcastle新城堡 area,
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位於Newcastle的,Newcastle地區的
04:37
and discovered發現 that only one in a hundred of them
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然後發現他們只有百分之一
04:40
had a plan計劃 about what to do when their hearts心中 stopped停止 beating跳動.
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有針對病患的心跳停止後的應變計畫
04:43
One in a hundred.
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百分之一
04:44
And only one in 500 of them had plan計劃 about what to do
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他們之中只有五百分之一
有針對病情惡化的
04:48
if they became成為 seriously認真地 ill生病.
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應變計畫
04:51
And I realized實現, of course課程, this dialogue對話
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然後我才了解,當然啦
04:54
is definitely無疑 not occurring發生 in the public上市 at large.
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這種話題是不會在公開場合討論的
04:58
Now, I work in acute急性 care關心.
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我現在在重症病房工作
05:00
This is John約翰 Hunter獵人 Hospital醫院.
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這間是John Hunter醫院
05:02
And I thought, surely一定, we do better than that.
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然後我想,對啊,我們的作法比較完善
05:06
So a colleague同事 of mine from nursing看護 called Lisa麗莎 Shaw and I
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所以我看護所的同事Lias Shaw和我
05:09
went through通過 hundreds數以百計 and hundreds數以百計 of sets of notes筆記
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仔細研究了成千上萬份的紀錄
05:11
in the medical records記錄 department
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收在醫療紀錄部裡面的
05:13
looking at whether是否 there was any sign標誌 at all
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我們想找出任何蛛絲馬跡
05:15
that anybody任何人 had had any conversation會話 about
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到底有沒有人曾經討論過
05:18
what might威力 happen發生 to them if the treatment治療 they were
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萬一他們正在進行的那些療程一直沒有效果
05:19
receiving接收 was unsuccessful不成功 to the point that they would die.
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而病人也只剩一口氣了,要怎麼辦?
05:23
And we didn't find a single record記錄 of any preference偏愛
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但是這麼多份醫生或病患的紀錄裡
05:26
about goals目標, treatments治療 or outcomes結果 from any
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關於這些情況的治療目標,治療方式或結果
05:30
of the sets of notes筆記 initiated啟動 by a doctor醫生 or by a patient患者.
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卻連一項都沒有提到
05:34
So we started開始 to realize實現
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因此我們才了解
05:37
that we had a problem問題,
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我們有問題
05:39
and the problem問題 is more serious嚴重 because of this.
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而這個問題之所以那麼嚴重,是因為
05:44
What we know is that obviously明顯 we are all going to die,
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我們都很清楚,人遲早一死
05:47
but how we die is actually其實 really important重要,
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而死因為何,對我們真的非常重要
05:50
obviously明顯 not just to us, but also to how that
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不僅對我們很重要,對所有曾目睹死亡
05:54
features特徵 in the lives生活 of all the people who live生活 on afterwards之後.
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的在世者而言,這種形象也非常重要
05:57
How we die lives生活 on in the minds頭腦 of everybody每個人
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我們死亡的形象,仍然存活在所有
05:59
who survives生存 us, and
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在世者的心中
06:02
the stress強調 created創建 in families家庭 by dying垂死 is enormous巨大,
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而目睹死亡會對家人產生極大的壓力
06:06
and in fact事實 you get seven times as much stress強調 by dying垂死
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事實上,處以重症看護的彌留病患
06:09
in intensive集約 care關心 as by dying垂死 just about anywhere隨地 else其他,
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承受的壓力是其他環境的七倍之多
06:11
so dying垂死 in intensive集約 care關心 is not your top最佳 option選項
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所以死於重症看護並不是你的最佳選擇
06:14
if you've got a choice選擇.
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如果你有選擇餘地的話
06:17
And, if that wasn't bad enough足夠, of course課程,
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當然,如果你覺得這樣還不夠慘
06:19
all of this is rapidly急速 progressing進展 towards the fact事實 that
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所有我們採取的作法都讓情況急速惡化了
06:22
many許多 of you, in fact事實, about one in 10 of you at this point,
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目前,你們會有很多人,事實上是十分之一
06:24
will die in intensive集約 care關心.
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死於重症看護
06:26
In the U.S., it's one in five.
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在美國,比例是五分之一
06:27
In Miami邁阿密, it's three out of five people die in intensive集約 care關心.
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在邁阿密,有五分之三的人死於重症看護
06:31
So this is the sort分類 of momentum動量
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所以這就是我們
06:33
that we've我們已經 got at the moment時刻.
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現在所處的態勢
06:35
The reason原因 why this is all happening事件 is due應有 to this,
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這就是這些事情會發生的原因
06:37
and I do have to take you through通過 what this is about.
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所以我必須帶你們深入探討這件事
06:39
These are the four ways方法 to go.
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我們有四個選擇
06:41
So one of these will happen發生 to all of us.
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我們會遇上其中一項
06:44
The ones那些 you may可能 know most about are the ones那些
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你們最熟悉的那個死因
06:46
that are becoming變得 increasingly日益 of historical歷史的 interest利益:
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也是醫療界越來越多人研究的
06:49
sudden突然 death死亡.
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猝死
06:50
It's quite相當 likely容易 in an audience聽眾 this size尺寸
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如果以現場觀眾人數的比例而言
06:52
this won't慣於 happen發生 to anybody任何人 here.
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你們當中不會有人猝死
06:54
Sudden突然 death死亡 has become成為 very rare罕見.
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猝死變得相當罕見
06:56
The death死亡 of Little Nell內爾 and Cordelia科黛拉 and all that sort分類 of stuff東東
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類似Little Nell和Cordelia的死因
06:59
just doesn't happen發生 anymore.
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再也沒出現過了
07:00
The dying垂死 process處理 of those with terminal終奌站 illness疾病
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我們剛剛看到的,罹患這種極嚴重病症的
07:03
that we've我們已經 just seen看到
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死亡過程
07:04
occurs發生 to younger更年輕 people.
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發生在年紀比較輕的人身上
07:05
By the time you've reached到達 80, this is unlikely不會 to happen發生 to you.
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等你活到80歲的時候,這種事不太可能發生在你身上
07:08
Only one in 10 people who are over 80 will die of cancer癌症.
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超過80歲的人,只有十分之一死於癌症
07:12
The big growth發展 industry行業 are these.
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比例大幅攀升的是這塊區域
07:16
What you die of is increasing增加 organ器官 failure失敗,
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你的死因是器官逐漸衰竭
07:20
with your respiratory呼吸, cardiac心臟的, renal,
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呼吸系統,心臟病,腎臟
07:22
whatever隨你 organs器官 packing填料 up. Each of these
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隨便哪個器官都行。每一個症狀都是
07:24
would be an admission入場 to an acute急性 care關心 hospital醫院,
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你進入醫院加護病房的通行證
07:26
at the end結束 of which哪一個, or at some point during which哪一個,
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到了最後,或是這期間的某個時刻
07:28
somebody says, enough足夠 is enough足夠, and we stop.
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有人會說,我受夠了,到此為止
07:30
And this one's那些 the biggest最大 growth發展 industry行業 of all,
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這是攀升幅度最大的區塊
07:33
and at least最小 six out of 10 of the people in this room房間
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今天現場的人,至少有十分之六
07:36
will die in this form形成, which哪一個 is
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會有這種死法,那就是
07:38
the dwindling日益減少 of capacity容量
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體力越來越差
07:42
with increasing增加 frailty脆弱,
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身體越來越虛弱
07:44
and frailty's脆弱的 an inevitable必然 part部分 of aging老化,
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而虛弱是不可逆轉的老化過程
07:47
and increasing增加 frailty脆弱 is in fact事實 the main主要 thing
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其實,日漸衰敗的身體才是
07:49
that people die of now,
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現代人最主要的死因
07:50
and the last few少數 years年份, or the last year of your life
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最後那幾年,或是說你生命中最後那幾年
07:52
is spent花費 with a great deal合同 of disability失能, unfortunately不幸.
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都困在重度失能的狀態,這很可悲
07:56
Enjoying享受 it so far? (Laughs)
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目前為止還不錯吧 (笑聲)
08:00
(Laughter笑聲)
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(笑聲)
08:03
Sorry, I just feel such這樣 a, I feel such這樣 a Cassandra卡桑德拉 here.
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不好意思,我只是覺得,我覺得現在變
Cassandra (希臘神話報噩耗的預言家)了
08:06
(Laughter笑聲)
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(笑聲)
08:11
What can I say that's positive? What's positive is
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這怎麼能稱上得上是件好事?這種好事是指
08:13
that this is happening事件 at very great age年齡, now.
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在現代社會,這發生在很老很老的人身上
08:15
We are all, most of us, living活的 to reach達到 this point.
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我們都能,我們大多數都能,活到那種歲數
08:18
You know, historically歷史, we didn't do that.
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你知道嗎,根據歷史紀載,我們以前沒辦法
08:20
This is what happens發生 to you
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當你活了一大把歲數
08:21
when you live生活 to be a great age年齡,
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這種事就會發生在你身上
08:24
and unfortunately不幸, increasing增加 longevity長壽 does mean
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不幸的是,平均壽命增加表示的是
08:25
more old age年齡, not more youth青年.
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老人會越來越多,不是年輕人
08:27
I'm sorry to say that. (Laughter笑聲)
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很遺憾宣佈這種消息 (笑聲)
08:33
What we did, anyway無論如何, look, what we did,
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總之,我們以前的做法,注意,我們以前的做法
08:35
we didn't just take this lying說謊 down
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我們以前不會束手待斃
08:37
at John約翰 Hunter獵人 Hospital醫院 and elsewhere別處.
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不管是在John Hunter醫院或是任何地方
08:38
We've我們已經 started開始 a whole整個 series系列 of projects項目
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我們推行了一連串的計畫
08:40
to try and look about whether是否 we could, in fact事實, involve涉及
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試著找出我們是否能做些甚麼,其實
08:43
people much more in the way that things happen發生 to them.
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這些嘗試涉及的人更多,包括那些不久於人世的
08:46
But we realized實現, of course課程, that we are dealing交易
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但是我們明白,當然,我們處裡的是
08:48
with cultural文化 issues問題,
200
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文化上的爭議
08:50
and this is, I love this Klimt克里姆特 painting繪畫,
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還有這個,我喜歡這幅Klimt的畫
08:52
because the more you look at it, the more you kind of get
202
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因為你們思考得越多,你們應該就越能了解
08:54
the whole整個 issue問題 that's going on here,
203
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2019
今天主要的議題是甚麼
08:56
which哪一個 is clearly明確地 the separation分割 of death死亡 from the living活的,
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3518
在生與死之間,畫出一條清晰的界線
09:00
and the fear恐懼 — Like, if you actually其實 look,
205
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1880
還有恐懼 - 比如說,如果你仔細看
09:01
there's one woman女人 there
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畫裡有個女人
09:03
who has her eyes眼睛 open打開.
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她的眼睛是張開的
09:05
She's the one he's looking at,
208
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1685
他在看的就是她
09:06
and [she's] the one he's coming未來 for. Can you see that?
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他就是為她而來的。你們看到沒有?
09:10
She looks容貌 terrified.
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她的樣子嚇呆了
09:11
It's an amazing驚人 picture圖片.
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這幅畫很不可思議
09:13
Anyway無論如何, we had a major重大的 cultural文化 issue問題.
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總之,以前我們最常遇見的文化爭議
09:15
Clearly明確地, people didn't want us to talk about death死亡,
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1984
顯然就是,沒有人想跟我們談論死亡
09:17
or, we thought that.
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或許是我們的誤解
09:18
So with loads負載 of funding資金 from the Federal聯邦 Government政府
215
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1947
所以聯邦政府撥出了一堆基金
09:20
and the local本地 Health健康 Service服務, we introduced介紹 a thing
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1420
在地的健康機構也是,我們跟你們介紹
09:22
at John約翰 Hunter獵人 called Respecting關於 Patient患者 Choices選擇.
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John Hunter醫院稱之為 “病患選擇優先權”
09:25
We trained熟練 hundreds數以百計 of people to go to the wards病房
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我們訓練了好幾百人,走進病房
09:28
and talk to people about the fact事實 that they would die,
219
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告訴他們,其實他們來日不多了
09:31
and what would they prefer比較喜歡 under those circumstances情況.
220
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然後問他們,事到如今,他們的想法是甚麼
09:33
They loved喜愛 it. The families家庭 and the patients耐心, they loved喜愛 it.
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他們喜歡這種做法。病人和家屬,他們都喜歡
09:36
Ninety-eight九八 percent百分 of people really thought
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百分之九十八的人認為
09:39
this just should have been normal正常 practice實踐,
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這應該納入例行手續
09:40
and that this is how things should work.
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本來就應該這樣做
09:43
And when they expressed表達 wishes祝福,
225
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1938
他們表達意願之後
09:45
all of those wishes祝福 came來了 true真正, as it were.
226
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1973
這些願望都實現了,都比照辦理
09:47
We were able能夠 to make that happen發生 for them.
227
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我們曾經有能力幫他們達成
09:49
But then, when the funding資金 ran out,
228
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2250
但是,基金用完了
09:51
we went back to look six months個月 later後來,
229
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2085
六個月之後,我們回去看的時後
09:53
and everybody每個人 had stopped停止 again,
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所有人又回歸起點
09:55
and nobody沒有人 was having these conversations對話 anymore.
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再也沒人討論這些問題了
09:58
So that was really kind of heartbreaking令人心碎 for us,
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所以我們真的覺得很失望
10:01
because we thought this was going to really take off.
233
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因為我們以為這件事已經上了軌道
10:03
The cultural文化 issue問題 had reasserted重申 itself本身.
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文化爭議再次現身聲明立場
10:07
So here's這裡的 the pitch瀝青:
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我的想法是:
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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在一路衝進加護病房之前,我們應該要仔細思考
10:12
to ICUICU without thinking思維 hard about whether是否 or not
237
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到底有沒有這個必要,讓每個人都以這種方式結束生命
10:15
that's where we all want to end結束 up,
238
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我認為這很重要
10:17
particularly尤其 as we become成為 older舊的 and increasingly日益 frail脆弱
239
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尤其是當我們老的時候,越來越虛弱
10:19
and ICUICU has less and less and less to offer提供 us.
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而加護病房能幫到我們的地方越來越少
10:23
There has to be a little side road
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對於那些不想走這條路的人
10:25
off there for people who don't want to go on that track跟踪.
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我們必須再開一條小路給他們選
10:29
And I have one small idea理念,
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對於未來可能發生的事
10:32
and one big idea理念 about what could happen發生.
244
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我有兩個見解,一大一小
10:36
And this is the small idea理念.
245
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這是比較簡單的作法
10:37
The small idea理念 is, let's all of us
246
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簡單的做法是,因為Jason
10:40
engage從事 more with this in the way that Jason賈森 has illustrated插圖.
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為我們指出了方向,所以我們都應該投入這場戰役
10:44
Why can't we have these kinds of conversations對話
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我們為什麼不能和自己的長輩
10:46
with our own擁有 elders長老
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那些大限將至的人
10:48
and people who might威力 be approaching接近 this?
250
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討論這些問題?
10:50
There are a couple一對 of things you can do.
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有兩件事你們都做得到
10:52
One of them is, you can,
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2131
第一件事是,你們可以
10:54
just ask this simple簡單 question. This question never fails失敗.
253
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問個簡單的問題。這個問題每試必靈
10:57
"In the event事件 that you became成為 too sick生病 to speak說話 for yourself你自己,
254
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3755
" 萬一你虛弱到連話都說不出來,
11:01
who would you like to speak說話 for you?"
255
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2933
你希望誰幫你說話?"
11:04
That's a really important重要 question to ask people,
256
648527
1914
提出這個問題真的很重要
11:06
because giving people the control控制 over who that is
257
650441
2023
因為如此能讓人們獲得自我的控制權
11:08
produces產生 an amazing驚人 outcome結果.
258
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產生的效果非常驚人
11:11
The second第二 thing you can say is,
259
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第二件事,你們可以問:
11:12
"Have you spoken to that person
260
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" 你有沒有跟那個人說過
11:14
about the things that are important重要 to you
261
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1920
對你而言很重要的事?
11:16
so that we've我們已經 got a better idea理念 of what it is we can do?"
262
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這樣我們才能更了解你,提供幫助會更有效。"
11:20
So that's the little idea理念.
263
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這是從小處看的見解
11:22
The big idea理念, I think, is more political政治.
264
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從大處來看,我覺得,要從政治著手
11:24
I think we have to get onto this.
265
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1951
我認為我們必須開始行動
11:26
I suggested建議 we should have Occupy佔據 Death死亡.
266
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我建議我們應該攻佔死亡 (死星)
11:29
(Laughter笑聲)
267
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(笑聲)
11:32
My wife妻子 said, "Yeah, right, sit-ins靜坐 in the mortuary停屍間.
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我老婆說: " 是啊,沒錯,在太平間靜坐抗議
11:34
Yeah, yeah. Sure." (Laughter笑聲)
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是啊,是啊。當然啦。" (笑聲)
11:37
So that one didn't really run,
270
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1865
所以這想法沒有真的執行
11:39
but I was very struck來襲 by this.
271
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但是這真的啟發了我
11:40
Now, I'm an aging老化 hippie嬉皮士.
272
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1713
現在,我是個老嬉皮了
11:42
I don't know, I don't think I look like that anymore, but
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我不知道,我覺得自己不像從前那樣了,可是
11:45
I had, two of my kids孩子 were born天生 at home in the '80s
274
689198
2500
我有兩個在自家接生,80年代的小孩
11:47
when home birth分娩 was a big thing, and we baby寶寶 boomers
275
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3468
那時候自家接生是件大事,我們是嬰兒潮世代
11:51
are used to taking服用 charge收費 of the situation情況,
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對這種情況已經駕輕就熟了
11:53
so if you just replace更換 all these words of birth分娩,
277
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3398
如果你試試,把"生產"換成其他字
11:57
I like "Peace和平, Love, Natural自然 Death死亡" as an option選項.
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我喜歡選 “和平,愛,自然死”
12:00
I do think we have to get political政治
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我真的認為我們應該推動政策
12:01
and start開始 to reclaim回收 this process處理 from
280
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2598
然後針對現行的醫療模式
12:04
the medicalized用醫學方法 model模型 in which哪一個 it's going.
281
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1967
著手開始進行改造
12:06
Now, listen, that sounds聲音 like a pitch瀝青 for euthanasia安樂死.
282
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2040
現在,注意,這些話很像是對安樂死的訴求
12:08
I want to make it absolutely絕對 crystal水晶 clear明確 to you all,
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我要完全明確地告訴你們
12:10
I hate討厭 euthanasia安樂死. I think it's a sideshow雜耍.
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我討厭安樂死。我認為那是無聊的把戲
12:13
I don't think euthanasia安樂死 matters事項.
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我不認為安樂死有用
12:15
I actually其實 think that,
286
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2151
我真的這樣想
12:17
in places地方 like Oregon俄勒岡,
287
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2549
像是Oregon (美國州名) 這種地方
12:20
where you can have physician-assisted醫生協助 suicide自殺,
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你可以請醫生幫你自殺
12:23
you take a poisonous有毒 dose劑量 of stuff東東,
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你喝下一劑有毒的東西
12:25
only half a percent百分 of people ever do that.
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只有百分之零點五的人這樣做
12:27
I'm more interested有興趣 in what happens發生 to the 99.5 percent百分
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我對另外百分之九十九點五的人比較有興趣
12:30
of people who don't want to do that.
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那些不想這樣做的人
12:32
I think most people don't want to be dead,
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我認為大多數的人都不想死
12:34
but I do think most people want to have some control控制
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但我認為大多數的人都想要控制
12:36
over how their dying垂死 process處理 proceeds收益.
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自己的死亡過程
12:39
So I'm an opponent對手 of euthanasia安樂死,
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所以我反對安樂死
12:40
but I do think we have to give people back some control控制.
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但是我認為我們應該要還一些控制權給人們
12:43
It deprives剝奪 euthanasia安樂死 of its oxygen supply供應.
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如此一來,安樂死就沒有容身之處了
12:46
I think we should be looking at stopping停止
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我認為我們的焦點應該是
12:47
the want for euthanasia安樂死,
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研究如何停止人們對於安樂死的需要
12:48
not for making製造 it illegal非法 or legal法律 or worrying令人擔憂 about it at all.
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至於它合不合法,這問題我們根本不用去擔心
12:53
This is a quote引用 from Dame貴婦人 Cicely西塞莉 Saunders桑德斯,
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這是Dame Cicely Saunders說過的話
12:57
whom I met會見 when I was a medical student學生.
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我還是醫學院讀書的時候遇到她
12:58
She founded成立 the hospice臨終關懷 movement運動.
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她創辦了安寧照顧基金會
13:01
And she said, "You matter because you are,
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然後她說,"你很重要,因為你就是你
13:03
and you matter to the last moment時刻 of your life."
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你的生命直到最後一刻都很重要。"
13:06
And I firmly牢牢 believe that
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我堅決相信這一點
13:08
that's the message信息 that we have to carry攜帶 forward前鋒.
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這就是我們要傳遞下去的訊息
13:11
Thank you. (Applause掌聲)
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謝謝大家 (掌聲)
Translated by Ho-chung Chou
Reviewed by FU SHIUNG KE

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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