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We Need to Talk Abo

游客2024-01-23  2
问题                                                              We Need to Talk About Death
A)       My mother wanted to die, but the doctors wouldn’t let her. At least that’s the way it seemed to me as I stood by her bed in an intensive-care unit at a hospital in Hilton Head, S. C. , five years ago. My mother was 79, a longtime smoker who was dying of emphysema (肺气肿). She knew that her quality of life was increasingly tied to an oxygen tank, that she was losing her ability to get about, and that she was slowly drowning. The doctors at her bedside were recommending various tests and procedures to keep her alive, but my mother, with a certain firmness I recognized, said no. She seemed puzzled and a bit frustrated that she had to be so insistent on her own death.
B)       The hospital at my mother’s assisted-living facility was sustained by Medicare, which pays by the procedure. I don’t think the doctors were trying to be greedy by pushing more treatments on my mother. That’s just the way the system works. The doctors were responding to the expectations of almost all patients. As a doctor friend of mine puts it, "Americans want the best, they want the latest, and they want it now." We expect doctors to make heroic efforts—especially to save our lives and the lives of our loved ones.
C)       The idea that we might ration health care to seniors (or anyone else) is political curse. Politicians do not dare breathe the word, lest they be accused—however wrongly—of trying to pull the plug on Grandma. But the need to spend less money on the elderly at the end of life is the elephant in the room in the health-reform debate. Everyone sees it but no one wants to talk about it. At a more basic level, Americans are afraid not just of dying, but of talking and thinking about death. Until Americans learn to regard death as more than a scientific challenge to be overcome, our health-care system will remain unfixable.
D)       Compared with other Western countries, the United States has more health care—but, generally speaking, not better health care. There is no way we can get control of costs, which have grown by nearly 50 percent in the past decade, without finding a way to stop overtreating patients. In his address to Congress, President Obama spoke airily about reducing inefficiency, but he slid past the hard choices that will have to be made to stop health care from devouring ever-larger slices of the economy and tax dollar. A significant portion of the savings will have to come from the money we spend on seniors at the end of life because, as Willie Sutton explained about why he robbed banks, that’s where the money is.
E)       As President Obama said, most of the uncontrolled growth in federal spending and the deficit comes from Medicare; nothing else comes close. Almost a third of the money spent by Medicare;—about $66.8 billion a year—goes to chronically ill patients in the last two years of life. This might seem obvious—of course the costs come at the end, when patients are the sickest. But that can’t explain what researchers at Dartmouth have discovered; Medicare spends twice as much on similar patients in some parts of the country as in others. The average cost of a Medicare patient in Miami is $16,351; the average in Honolulu is $5,311. In the Bronx, N. Y. , it’s $12,543. In Fargo, N. D. , $5, 738. The average Medicare patient undergoing end-of-life treatment spends 21.9 days in a Manhattan hospital. In Mason City, Iowa, he or she spends only 6.1 days.
F)       All this treatment does not necessarily buy better care. In fact, the Dartmouth studies have found worse outcomes in many states and cities where there is more health care. Why? Because just going into the hospital has risks—of infection, or error, or other unforeseen complications. Some studies estimate that Americans are over treated by roughly 30 percent. "It’s not about rationing care—that’s always the bogeyman (魔鬼) people use to block reform," says Dr. Elliott Fisher, a professor at Dartmouth Medical School. "The real problem is unnecessary and unwanted care."
G)       But how do you decide which treatments to cut out? How do you choose between the necessary and the unnecessary? There has been talks among experts and lawmakers of giving more power to a panel of government experts to decide—Britain has one, called the National Institute for Health and Clinical Excellence (known by the somewhat ironic acronym NICE). But no one wants the horror stories of denied care and long waits that are said to plague state-run national health-care systems. After the summer of angry town halls, no politician is going to get anywhere near something that could be called a "death panel".
H)       Ever-rising health-care spending now consumes about 17 percent of the economy. At the current rate of increase, it will devour a fifth of GDP by 2018. We cannot afford to sustain a productive economy with so much money going to health care. Over time, economic reality may force us to adopt a national health-care system like Britain’s or Canada’s. But before that day arrives, there are steps we can take to reduce costs without totally turning the system inside out.
I)       Other initiatives ensure that the elderly get counseling about end-of-life issues. Although called as a "death panel", a program in Wisconsin to get patients to talk to their doctors about how they want to deal with death was actually an outstanding success. A study by the Archives of Internal Medicine shows that such conversations between doctors and patients can decrease costs by about 35 percent—while improving the quality of life at the end.
J)       Patients should be encouraged to draft living wills to make their end-of-life desires known. Unfortunately, such paper can be useless if there is a family member at the bedside demanding heroic measures. "A lot of the time guilt is playing a role," says Dr. David Torchiana, a surgeon and CEO of the Massachusetts General Physicians Organization. Doctors can feel guilty, too— about overtreating patients. Torchiana recalls his unease over operating to treat a severe heart infection in a woman with two forms of metastatic (转移性的) cancer who was already comatose (昏迷的). The family insisted.
K)       Studies show that about 70 percent of people want to die at home—but that about half die in hospitals. There has been an important increase in hospice (临终安养院) or palliative (姑息的) care—keeping patients with incurable diseases as comfortable as possible while they live out the remainder of their lives. Hospice services are generally intended for the terminally ill in the last six months of life, but as a practical matter, many people receive hospice care for only a few weeks.
L)       That’s what my mother wanted. After convincing the doctors that she meant it—that she really was ready to die—she was transferred from the ICU to a hospice, where, five days later, she passed away. In the ICU, as they removed all the monitors and pulled out all the tubes and wires, she made a shaking motion with her hands. She seemed to be signaling goodbye to all that—I’m free to go in peace. [br] Medicare is the reason for the majority of the uncontrolled growth in federal spending and the deficit.
选项
答案 E
解析 同义转述题。定位句讲述了奥巴马总统承认大部分联邦开支和赤字增长失控都源于医疗保险。题干中的is the reason for对应原文中的comes from，故答案为E。
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