试题详情

Text l How,when and where death happens has changed over the past century.As late as 1990 half of deaths worldwide were caused by chronic diseases;in 2015 the share was two-thirds.Most deaths in rich countries follow years of uneven deterioration.Roughly two-thirds happen in a hospital or nursing home.They often come after a ctimax of desperate treatment.Such passionate intervention can be agonising for all concerned.These medicalised deaths do not seem to be what people want.Polls find that most people in good health hope that,when the time comes,they will die at home.They want to die free from pain,at peace,and surrounded by loved ones for whom they are not a burden.But some deaths are unavoidably miserable.Not everyone will be in a condition to toast death"s imminence with champagne,as Anton Chekhov did.What people say they will want while they are well may change as the end nears.Dying at home is less appealing if all the medical kit is at the hospital.A treatment that is unbearable in the imagination can seem like the lesser of two evils when the alternative is death.Some patients will want to fight until all hope is lost.But too often patients receive drastic treatment in spite of their dying wishes~by default,when doctors do"everything possible",as they have been trained to,without talking through people"s preferences or ensuring that the prediction is clearly understood.The legalisation of doctor-assisted dying has been called for,so that mentally fit,terminally ill patients can be helped to end their lives if that is their wish.But the right to die is just one part of better care at the end of life.The evidence suggests that most people want this option,but that few would,in the end,choose to exercise it.To give people the death they say they want,medicine should take some simple steps.More palliative care is needed.Providing it earlier in the course of advanced cancer alongside the usual treatments turns out not only to reduce suffering,but to prolong life,too.Most doctors enter medicine to help people delay death,not to talk about its inevitability.But talk they must.Medicare,America"s public health scheme for the over-65s,has recently started paying doctors for in-depth conversations with terminally ill patients;other national health-care systems,and insurers,should follow.Cost is not an obstacle,since informed,engaged patients will be less likely to want pointless procedures.Fewer doctors may be sued,as poor communication is a common theme in malpractice claims. A ceniury ago,death was characterized as being_____