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  3. The Case for Killing My MotherA)My mother wanted to die,but

The Case for Killing My MotherA)My mother wanted to die,but

游客2023-07-05  29
问题                     The Case for Killing My Mother
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 continuing 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 fives of our loved ones.
C)The idea that we might ration health care to seniors or lonely else is political curse. Politicians do not dare breathe the word, lest they be accused—however wrongly—of trying to pull the plug on mother. 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 overcoat, 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 over eating 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 rubbed 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 smartarse 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 sonic 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.
F)And 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. Some studies estimate that Americas 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 talk 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. 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 stops 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 demagogue(蛊惑民心的政客)as a "death panel", a program in Wisconsin to get patients to talk to their doctors about how they want to deal win death was actually an outstanding success. A study by the Archives of Intermale Medicine shows that such conversations between doctors and patients call 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 little guilt is playing a role," says Dr. David Tokharian, a surgeon and CEO of the Massachusetts General Physicians Organization. Doctors can feel guilty, too—about over treating Patients Diana, recalls his unease over operating to treat a severe heart infection in a woman with two forms of metastatic(转移)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(临终关怀病房)palliative(缓解的)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] According to the study by the Archives of Intermale Medicine, conversations between doctors and patients decrease costs while improving the quality of the end.
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答案 I
解析 题干关键词为Archives of Intermale Medicine和conversations betweendoctors and patients。文中I段提到，A study by the Archives of Intermale Medicineshows that such conversations between doctors and patients call decrease costs by about35 percent--while improving the quality of life at the end，与题干意思一致，故选I。
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