TED演讲 | 让我们来谈谈死亡

Look, I had second thoughts, really,

说实话，我犹豫过

about whether I could talk about this

到底应不应该

to such a vital and alive audience as you guys.

对你们一群如此有活力的观众讲这个题目。

Then I remembered the quote from Gloria Steinem,

但我又想起了Gloria Steinem的一句话

which goes,

她是这样说的

"The truth will set you free,

“真相会给你自由，

but first it will piss you off."

但它会先令你难受”

So...

所以呢……

So with that in mind, I'm going to set about

所以谨记着这一点，我要开始

trying to do those things here,

试图来谈谈这些事

and talk about dying in the 21st century.

聊一聊21世纪的死亡。

Now the first thing that will piss you off, undoubtedly,

首先，第一件会令你们十分不爽的，毫无疑问的，

is that all of us are, in fact, going to die

就是我们所有人，事实上，都将在

in the 21st century.

21世纪死去。

There will be no exceptions to that.

这不会有例外吧！

There are, apparently, about one in eight of you

可是根据调查，我们当中每8个人就会有1个

who think you're immortal, on surveys, but --

觉得自己可以长生不老，但是……

Unfortunately, that isn't going to happen.

不幸的是，长生不老是不可能的。

While I give this talk, in the next 10 minutes,

在接下来的这10分钟内，就在我做这个演讲的同时，

a hundred million of my cells will die,

我身体里的一亿个细胞将死去，

and over the course of today, 2,000 of my brain cells

今天，我的2000个脑细胞会死去

will die and never come back,

而且永远不会回来。

so you could argue that the dying process

所以可以说，死亡的过程

starts pretty early in the piece.

其实在这类的日常小事中就开始了。

Anyway, the second thing I want to say about dying in the

无论如何，我想说的关于死在21世纪的第二件事是，

21st century, apart from it's going to happen to everybody,

除了这件事会发生在每个人的身上以外，

is it's shaping up to be a bit of a train wreck

它对大部分人来说，就是一列好好的火车

for most of us,

最终是怎么走向撞车和成为一个残骸的过程。

unless we do something to try and reclaim this process

除非我们做点什么，把这列火车

from the rather inexorable trajectory that it's currently on.

从它现在正向着的死亡方面前进的轨道上拉回来。

So there you go. That's the truth.

这就是我要告诉你的真相。

No doubt that will piss you off, and now let's see

毫无疑问，这会让你非常不爽，但现在我们来看看

whether we can set you free. I don't promise anything.

可不可以让你获得自由并重生。但我不能向你保证什么。

Now, as you heard in the intro, I work in intensive care,

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，

and I think I've kind of lived through the heyday

而且我想我经历过ICU的黄金时期。

of intensive care. It's been a ride, man.

那就像坐过山车一样，

This has been fantastic.

那真的一直都很棒。

We have machines that go ping.

我们有很先进的设备。

There's many of them up there.

这照片上就有很多啊。

And we have some wizard technology which I think

我们有一些魔术般的技术，

has worked really well, and over the course of the time

我觉得一直以来都很好用。

I've worked in intensive care, the death rate

在我在ICU工作的时间里，

for males in Australia has halved,

澳大利亚的男性死亡率减少了一半，

and intensive care has had something to do with that.

这跟ICU特护是有关系的。

Certainly, a lot of the technologies that we use

当然，这跟我们采用的许多技术

have got something to do with that.

也有很大的关系。

So we have had tremendous success, and we kind of

所以我们取得过巨大的成功，

got caught up in our own success quite a bit,

而我们有点被自己的成功冲昏了头脑，

and we started using expressions like "lifesaving."

所以，我们开始用一些像是“挽救生命”之类的词形容自己

I really apologize to everybody for doing that,

为此我真的要对所有人表示歉意，

because obviously, we don't.

因为，很明显，我们并不能救命。

What we do is prolong people's lives,

我们能做的是延长人们的生命，

and delay death,

让死亡迟一点到来，

and redirect death, but we can't, strictly speaking,

让死亡的过程改变一点点，但是严格来说，

save lives on any sort of permanent basis.

从任何永久性的角度看，我们并不能拯救病人的生命。

And what's really happened over the period of time

而从我在ICU这些年的工作经验来看，

that I've been working in intensive care is that

事实的真相是，

the people whose lives we started saving back in the '70s,

我们在70年代，80年代，

'80s, and '90s, are now coming to die in the 21st century

90年代所救过来的人，现在慢慢开始在21世纪逝去

of diseases that we no longer have the answers to

死于我们当时没法治愈

in quite the way we did then.

现在也一样没法的治愈的疾病。

So what's happening now is there's been a big shift

而最大的不同点是，

in the way that people die,

人们死亡的方式发生了巨大的转变。

and most of what they're dying of now isn't as amenable

而大部分让人们致死的疾病

to what we can do as what it used to be like

已经和我们当年

when I was doing this in the '80s and '90s.

在80年代、90年代处理的方法有了很大的不同了。

So we kind of got a bit caught up with this,

所以我们也有点困惑

and we haven't really squared with you guys about

而我们也没有机会和大家分享一下

what's really happening now, and it's about time we did.

如今ICU里都在发生什么。现在就让我们来看一下。

I kind of woke up to this bit in the late '90s

我是在90年代后期才思考这个问题的，

when I met this guy.

当时我遇到了这个人。

This guy is called Jim, Jim Smith, and he looked like this.

他叫做Jim Smith，他当时的样子是这样的。

I was called down to the ward to see him.

我被叫到病房去看他。

His is the little hand.

他的小手可以说是骨瘦如柴。

I was called down to the ward to see him

一名呼吸内科医生

by a respiratory physician.

将我叫到他的诊室。

He said, "Look, there's a guy down here.

他对我说：“那有个病人”

He's got pneumonia,

他得的是肺炎，

and he looks like he needs intensive care.

看样子他需要入你们的ICU病房。

His daughter's here and she wants everything possible

他的女儿在这，

to be done."

她希望你们能尽一切办法……

Which is a familiar phrase to us.

这是我们常听到的一句话。

So I go down to the ward and see Jim,

所以，我去病房去看Jim Smith.

and his skin his translucent like this.

他的皮肤半透明成了这个样子。

You can see his bones through the skin.

透过他的皮肤，你们以看到他的骨头。

He's very, very thin,

他可是说是瘦骨嶙峋。

and he is, indeed, very sick with pneumonia,

他的肺炎已是相当严重了

and he's too sick to talk to me,

病得连和我们讲话的力气都没有了

so I talk to his daughter Kathleen, and I say to her,

所以，我问他的女儿Kathleen:

"Did you and Jim ever talk about

"你有没有和他谈过"

what you would want done

你会怎么处理这个事，

if he ended up in this kind of situation?"

如果他到了这种地步？

And she looked at me and said, "No, of course not!"

她看了看我，然后说：”没有，当然没有“

I thought, "Okay. Take this steady."

好吧，我当时想，慢慢做她的工作吧。

And I got talking to her, and after a while, she said to me,

我和她谈了很久，然后，她对我说：

"You know, we always thought there'd be time."

你知道的，我们也知道，迟早会有那一天的。

Jim was 94.

当时已经94岁了。

And I realized that something wasn't happening here.

这件事让我觉得，我们可以为这类病人做些事。

There wasn't this dialogue going on

要不是有这件事

that I imagined was happening.

我也想象不到我们会不会去做这件事。

So a group of us started doing survey work,

所以，我们有一个小组开始做一些调查工作，

and we looked at four and a half thousand nursing home

我们走访了

residents in Newcastle, in the Newcastle area,

Newcastle地区的4500个在养老院生活的老人，

and discovered that only one in a hundred of them

我们发现，他们当中只有1%的人

had a plan about what to do when their hearts stopped beating.

对他们生理死亡后的事有计划。

One in a hundred.

仅仅1%。

And only one in 500 of them had plan about what to do

只有500分之1的老人

if they became seriously ill.

会对他们病重时有应对计划。

And I realized, of course, this dialogue

这个对话使我意识到，

is definitely not occurring in the public at large.

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。

Now, I work in acute care.

现在，我在ICU里工作。

This is John Hunter Hospital.

我的医院叫“John Hunter”医院。

And I thought, surely, we do better than that.

而过去我一直认为，我们做得比较好。

So a colleague of mine from nursing called Lisa Shaw and I

所以，我和我的同事Lisa Shaw，她来自养老院，

went through hundreds and hundreds of sets of notes

我们一起在医疗档案室

in the medical records department

翻看了成千上万本病历,

looking at whether there was any sign at all

我们想确认是否有

that anybody had had any conversation about

任何人曾经

what might happen to them if the treatment they were

就如果他们的治疗失败

receiving was unsuccessful to the point that they would die.

而导致他们死亡而作出任何安排的谈话。

And we didn't find a single record of any preference

可是，我们找不到关于他们的自我选择，

about goals, treatments or outcomes from any

目标、治疗或者最终结果这方面的东西

of the sets of notes initiated by a doctor or by a patient.

医生记录或病人自己写的都没有。

So we started to realize

我这才意识到

that we had a problem,

我们出了问题，

and the problem is more serious because of this.

而正因为这一点，这个问题变得更严重。

What we know is that obviously we are all going to die,

我们大家都知道的是很明显，我们都会死去，

but how we die is actually really important,

但我们以何种方式死去更重要，

obviously not just to us, but also to how that

很明显，这不仅对我们重要，

features in the lives of all the people who live on afterwards.

这对那些活着的人也很重要。

How we die lives on in the minds of everybody

其实我们会怎样死去，

who survives us, and

这在抢救我们的人的心中是心里有数的,

the stress created in families by dying is enormous,

而死亡给一个家庭带来的压力是巨大的，

and in fact you get seven times as much stress by dying

事实上，死在ICU所带来的压力

in intensive care as by dying just about anywhere else,

是死在其它地方所带来的压力的7倍，

so dying in intensive care is not your top option

所以，选择在ICU结束自己的生活并不是一个明智的决定

if you've got a choice.

如果你有得选择的话。

And, if that wasn't bad enough, of course,

如果这还不算太糟糕的话，当然

all of this is rapidly progressing towards the fact that

我们很快可以看到另一个数据

many of you, in fact, about one in 10 of you at this point,

很多人，事实上，大约10个人当中就有1个

will die in intensive care.

会死在ICU中。

In the U.S., it's one in five.

而在美国，这个数字是每5个人当中有1个。

In Miami, it's three out of five people die in intensive care.

在迈阿密，这个数字是每5个人当中有3个。

So this is the sort of momentum

这就是我们目前所看到的

that we've got at the moment.

发展势头。

The reason why this is all happening is due to this,

事情会变成这个样子主要是因为这个。

and I do have to take you through what this is about.

而我要带领大家去一起探讨一下其原因。

These are the four ways to go.

21世纪主要有四种死亡形式。

So one of these will happen to all of us.

我们所有人都会以其中的一种形式死去。

The ones you may know most about are the ones

人们最熟知的死亡方式

that are becoming increasingly of historical interest:

也是越来越引起我们关注的一种死亡方式

sudden death.

猝死。

It's quite likely in an audience this size

在我们这样的观众群中，

this won't happen to anybody here.

可能不会有这种死亡。

Sudden death has become very rare.

猝死现在已经很少见了。

The death of Little Nell and Cordelia and all that sort of stuff

像Little Nell或Condelia那样猝死的案例

just doesn't happen anymore.

现在已经很少了。

The dying process of those with terminal illness

现在因为患绝症而死亡的病人

that we've just seen

正如我们刚才看到的一样，

occurs to younger people.

在年轻人中的发病率越来越高了。

By the time you've reached 80, this is unlikely to happen to you.

到你80岁，这也不可能发生在你身上。

Only one in 10 people who are over 80 will die of cancer.

现在80岁年龄层中只有10%的人死于癌症。

The big growth industry are these.

而造成死亡最多的因素主要在以下几个方面。

What you die of is increasing organ failure,

越来越多的人死于器官功能衰竭

with your respiratory, cardiac, renal,

如呼吸和心、肾功能衰竭等等。

whatever organs packing up. Each of these

不管以上那个器官出了问题

would be an admission to an acute care hospital,

病人都要紧急送院治疗，

at the end of which, or at some point during which,

到最后，或者在治疗过程中的某一时间上

somebody says, enough is enough, and we stop.

直到有人对我们说不用治了，我们才放弃。

And this one's the biggest growth industry of all,

这是我们见得最多的案例，

and at least six out of 10 of the people in this room

每10个在这里听演讲的人中就会有6个

will die in this form, which is

将会以这种方式结束我们的一生，

the dwindling of capacity

这是因为功能的缺失

with increasing frailty,

造成的生命的脆弱，

and frailty's an inevitable part of aging,

而脆弱是老龄化不可避免的进程，

and increasing frailty is in fact the main thing

而脆弱事实上就是

that people die of now,

现代人死亡的主要原因，

and the last few years, or the last year of your life

你生命的最后一年或几年时间

is spent with a great deal of disability, unfortunately.

你都会在能力缺失中度过，这太不幸了。

Enjoying it so far?

你们还承受得住么？

Sorry, I just feel such a, I feel such a Cassandra here.

对不起，我怎么成了一个卡珊德拉式的预言家了呢。

What can I say that's positive? What's positive is

但积极的一面是

that this is happening at very great age, now.

这只发生在老年人当中。

We are all, most of us, living to reach this point.

我们大家也都会经历这一时期的。

You know, historically, we didn't do that.

要知道，以住要活到这么长的人不多的。

This is what happens to you

这种死亡方式

when you live to be a great age,

只会发生在那些高龄人身上，

and unfortunately, increasing longevity does mean

不幸的是，寿命的延长

more old age, not more youth.

延长的不是青春，而是老年的时光。

I'm sorry to say that.

很遗憾这样说。

What we did, anyway, look, what we did,

不管怎么说，我们所做的

we didn't just take this lying down

我们并不仅仅指那些

at John Hunter Hospital and elsewhere.

在John Hunter医院逝去的人或在其它地方死去的人。

We've started a whole series of projects

我们已经开始一系列的项目

to try and look about whether we could, in fact, involve

尝试去了解我们能否让更多的人

people much more in the way that things happen to them.

参与到那些可能发生到他们身上去的事。

But we realized, of course, that we are dealing

然而，我们当然意识到

with cultural issues,

我们要应对一些文化层面的问题，

and this is, I love this Klimt painting,

我喜欢这张克里姆特的画，

because the more you look at it, the more you kind of get

这是因为，你越看它，

the whole issue that's going on here,

你越能了解发生在这里的一切，

which is clearly the separation of death from the living,

而这明显是一种死与生，

and the fear.Like, if you actually look,

和恐惧的分隔。比如说，如果你仔细看的话，

there's one woman there

你会发现有个女人

who has her eyes open.

她的眼睛是睁着的。

She's the one he's looking at,

他在看着她，

and she's the one he's coming for. Can you see that?

他就是冲着她来的。你们看到了吗？

She looks terrified.

她看起来很惊恐。

It's an amazing picture.

这是一幅很不错的画。

Anyway, we had a major cultural issue.

另外，我们还有一个主要的文化层面的问题。

Clearly, people didn't want us to talk about death,

显而易见，人们并不希望我们和他们谈论死亡，

or, we thought that.

或者，我们自己如此认为。

So with loads of funding from the Federal Government

所以，在联邦政府和地方卫生部门资金的支持下

and the local Health Service, we introduced a thing

我们在John Hunter医院引入了

at John Hunter called Respecting Patient Choices.

一个名为“尊重病人的选择”的项目

We trained hundreds of people to go to the wards

我们培训了成百上千的工作人员，

and talk to people about the fact that they would die,

派他到病房去告诉别人他们大限将至

and what would they prefer under those circumstances.

然后问他们有什么打算。

They loved it. The families and the patients, they loved it.

此举受到病人和家属的欢迎。

Ninety-eight percent of people really thought

98%的人真的认为

this just should have been normal practice,

这应该成为一种常态化的做法，

and that this is how things should work.

同时，这也是顺应自然的做法。

And when they expressed wishes,

而当这些病人表达他们的意愿的时候，

all of those wishes came true, as it were.

所有这些意愿都可以实现。

We were able to make that happen for them.

我们可以帮他们实行他们的意愿。

But then, when the funding ran out,

然而，当这笔资金用完之后中，

we went back to look six months later,

六个月后我们再来评估这一项目，

and everybody had stopped again,

这一做法又被停止了。

and nobody was having these conversations anymore.

也没有人去进行这方面的谈话了。

So that was really kind of heartbreaking for us,

这是一种很令我们心酸的结局，

because we thought this was going to really take off.

因为我们一直以为，这会成为一种常态化的东西。

The cultural issue had reasserted itself.

文化问题又一次得到了体现。

So here's the pitch:

这就是问题所在。

I think it's important that we don't just get on this freeway

我认为，在我们决定走上去ICU这条路时，

to ICU without thinking hard about whether or not

我们真的要想

that's where we all want to end up,

我们是否真的想死在ICU里，

particularly as we become older and increasingly frail

这点在我们老态龙钟和变得脆弱不堪时尤其重要，

and ICU has less and less and less to offer us.

这时，ICU能为我们做的事情是少之又少的。

There has to be a little side road

如果不去ICU,肯定还有其它的选择的

off there for people who don't want to go on that track.

前提是——你不想死在ICU里。

And I have one small idea,

而对于可能发生的事，我有一个“小”主意

and one big idea about what could happen.

我一个“大”主意

And this is the small idea.

我的小主意是：

The small idea is, let's all of us

让我们所有人

engage more with this in the way that Jason has illustrated.

更多地象Jason所描述的那样。

Why can't we have these kinds of conversations

我们为什么就不能和Jason一样

with our own elders

和我们的长辈

and people who might be approaching this?

或者那些正在慢慢变老的人和Jason一样谈一下这个问题呢？

There are a couple of things you can do.

你可以为此做一些事情。

One of them is, you can,

其中一个是，

just ask this simple question. This question never fails.

你只需问一个简单的问题。这是一个很有用的问题。

"In the event that you became too sick to speak for yourself,

“万一你病得不能讲话了，

who would you like to speak for you?"

你想让谁代你表达你的心声呢？”

That's a really important question to ask people,

这真是一个非常重要的问题，

because giving people the control over who that is

这是因为，给予谁这个权利

produces an amazing outcome.

会给你带来不同的结局。

The second thing you can say is,

你可以说的第二个事情是，

"Have you spoken to that person

“你和哪个人谈过了

about the things that are important to you

你认为对你来说是很重要的事吗

so that we've got a better idea of what it is we can do?"

那样我们就比较清楚我们能为你做些什么。

So that's the little idea.

这就是我的“小”主意。

The big idea, I think, is more political.

我的大主意，我认为更实用。

I think we have to get onto this.

我认为，我们必须做好一件事。

I suggested we should have Occupy Death.

我建议搞一个“占领死亡”运动（Occupy Death）

My wife said, "Yeah, right, sit-ins in the mortuary.

我妻子对我说，“对，对，到太平间去静坐”

Yeah, yeah. Sure."

对，应该的。

So that one didn't really run,

所以，这个行不通，

but I was very struck by this.

但我还是受到一些打击的。

Now, I'm an aging hippie.

现在，我是一个老嬉皮士。

I don't know, I don't think I look like that anymore, but

我不知道，我并不认为我还象一个嬉皮士，但是

I had, two of my kids were born at home in the '80s

在90年代，我的两个小孩都是在家里生产的

when home birth was a big thing, and we baby boomers

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

are used to taking charge of the situation,

已经习惯了处理这些事，

so if you just replace all these words of birth,

所以，如果你要替换掉这些关于生产的字，

I like "Peace, Love, Natural Death" as an option.

我会选择“和平、爱和自然死亡”

I do think we have to get political

我真的认为，我们必须得面对现实

and start to reclaim this process from

并且重申这一进程

the medicalized model in which it's going.

从我们现行的医疗化模型中解放出来

Now, listen, that sounds like a pitch for euthanasia.

听走来，好像我又在鼓吹安乐死。

I want to make it absolutely crystal clear to you all,

我想向各位澄清一下

I hate euthanasia. I think it's a sideshow.

我讨厌安乐死。我认为那是一个次要的问题。

I don't think euthanasia matters.

我不认为安乐死会有什么好处

I actually think that,

事实上，我认为，

in places like Oregon,

在象Oregon这类地方，

where you can have physician-assisted suicide,

你可以寻求到一些在医生的辅助下的自杀方式，

you take a poisonous dose of stuff,

你可以吃点毒药之类的东西，

only half a percent of people ever do that.

可只有0.5%的人做过这样的蠢事。

I'm more interested in what happens to the 99.5 percent

其实，我对其它的99.5%的

of people who don't want to do that.

不想通过服毒而死去的人感兴趣。

I think most people don't want to be dead,

我想，大多数人都不想死，

but I do think most people want to have some control

但我认为，大多数人都想能够控制

over how their dying process proceeds.

自己死亡的过程。

So I'm an opponent of euthanasia,

所以，我反对安乐死，

but I do think we have to give people back some control.

但我又认为，我们应该给病重的人一些自己控制权。

It deprives euthanasia of its oxygen supply.

这能够让安乐死失去理由。

I think we should be looking at stopping

我认为，我们应该去尝试了解病人

the want for euthanasia,

想要安乐死背后的原因，

not for making it illegal or legal or worrying about it at all.

而不只是让它合法代或非法，或者毫不关心。

This is a quote from Dame Cicely Saunders,

这是Dame Cicely Saunders的一句话，

whom I met when I was a medical student.

我还是一个医学院学生的时候遇过她

She founded the hospice movement.

她创立了护理所运动。

And she said, "You matter because you are,

她说，“你就是你，你是重要的，

and you matter to the last moment of your life."

直到你生命的最后一刻。“

And I firmly believe that

我坚定地相信

that's the message that we have to carry forward.

这是我们应该继续前行的旨意

Thank you.

谢谢