This is slippery territory. The Medicare Hospice Benefit act, passed by Congress 30 yearsago, offers palliative care to those expected to die within six months, but requires that oncethey take it up, treatment for their condition must stop. That puts many patients off. Andwhen they hear palliative care and hospice, their usual reaction is, I m not that far goneyet. Yet hospice patients typically last only two or three weeks. As Dr Byock says, this hasbecome brink-of-death care.
姑息疗法处境尴尬。美国国会30年前通过了《临终关怀医疗保障法案》,为那些预期寿命只有6个月的病人提供姑息疗法。但是根据该法案,病人一旦选择了姑息疗法,就不得再接受对其病症的治疗,使得许多病人望而却步。而且人们听到姑息疗法或者临终关怀,总会觉得:我的情况还没有那么糟吧。所以,大多数接受临终关怀的病人往往只能生存两到三周。正如Byock所说,这成了死亡边缘的关怀。
Nor is it easy to decide when to stop making every effort to save someone s life and allowthem to die gently. The book quotes the case of one HIV-positive young man who was acutelyill with multiple infections. He spent over four months in hospital, much of the time on aventilator, and had countless tests, scans and other interventions. The total bill came to over$1m. He came close to death many times, but eventually pulled through and has nowreturned to a normal life. It is an uplifting story, but such an outcome is very rare.
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