2015年经济学人 家中安息 家庭援助（在线收听）

Dying at home

家中安息

Home help

家庭援助

The government wants you to have a comfortable (and cheap) death

政府愿您安乐（又经济）的告别人世

Still, it's better than hospital

家还是比医院好

DEATH comes to all, but some are more sure of its timing, and can make plans. Kate Granger, a 32-year-old doctor suffering from an incurable form of sarcoma, has “very strong ambitions” for her last hours. She plans to avoid hospital emergency departments and die at her parents' house—music playing, candles glowing, family by her side.

每个人都会死，但是有些人却更加清楚自己何时会死，且可以提前做好计划。32岁的凯特·格兰格是一位医生，却身患无法治愈的恶性肿瘤，她对自己剩下的时间有巨大的野心。她不打算死在医院的急诊室，而是她父母的房子—音乐为歌，烛光为舞，亲人相伴。

Surveys show that over two-thirds of Britons would like to die at home. Like Dr Granger, they want to be with family and free of pain. Yet hospital remains the most common place of death. For some this is unavoidable—not every disease has as clear a turning point as cancer—but for others a lack of planning is to blame. The government, motivated by both compassion and thrift, wants to help.

调查显示，三分之二的英国人都意欲在家面对死亡。就像格兰格医生一样，他们想在亲人身边，免受病痛折磨。然而医院仍旧是死神降临最常见的地方。这在某种程度上是不可避免的—不是每种疾病都像癌症一样有一个明显的转折点—但是对其他疾病来说，缺乏规划则应负主要责任。在同情心和节俭理念共同的驱使下，政府需要伸出援助之手。

In death, at least, public wishes align neatly with the state's desire to save money. The NHS has calculated that if roughly one more patient per general practitioner died outside hospital each year, it would save 180m ($295m). In 2008 it introduced a broad end-of-life care strategy, which sought to increase awareness of how people die while improving care. Since then the proportion of people dying at home or in care homes (the split is about half-and-half between them) has increased, from 38% to 44%.

至少在面对死亡时，公众的愿望刚好和国家想要省钱的愿望结合在一起。英国国民健康保险制度已经大致计算出，如果每年每个普通医师医治的病人在原来的基础上增加一个选择死在医院外面，就会节省1.8亿英镑（约合2.95亿美元）。2008年，国家介绍了一个大范围的临终关怀方案，意欲在提升护理的同时增加人们对如何死亡的认知。自那时起，选择死在家里或者老人院的人数（以上两种情况大约五五开）已经从38%增加到了44%。

To steer patients away from hospitals, general practitioners have been encouraged to find their 1%—those patients likely to die in the next year—and start talking about end-of-life care. This can be difficult for doctors. “As a profession we view death as failure,” says Dr Granger. Yet when there is no cure to be had, planning for death can be therapeutic for patients.

为了引导病人们出院，普通医师已经开始鼓励找到那1%即将在下一年离世的病人，并且开始对他们采取临终护理。对医生来说这很困难。格兰格说“作为医生，我们将死亡看做失败”。即使没有什么治疗方法，为死亡做好充分的计划对病患来说也是有益的。

Those who do plan ahead are much more likely to have their wishes met. A growing number of patients have electronic “palliative-care co-ordination systems”, which allow doctors to register personal preferences so that other care providers can follow them. A paramedic called to a patient's home would know of a do-not-resuscitate order, for example. One study showed that such systems increase the number of people dying in their homes.

提前计划的人更有机会实现愿望。越来越多的病人都有了电子“疗养协调系统”，这使得医生可以把个人喜好输入系统，其他疗养提供者可以按医生嘱咐执行。比如说护理人员给病人家里打电话，会了解到他们不愿再接受治疗的愿望。一调查显示，这个系统增加了在家死亡的人数。

But savings for the government may mean costs for charities and ordinary folk. At the end of life it is not always clear who should pay for what. Although Britons can get ordinary health care without paying out of pocket, social care is means-tested. People must often shell out for carers or care homes—or look after the terminally ill themselves. Disputes crop up over trivial things, like responsibility for the cost of a patient's bath.

但政府的存款可能要支付慈善机构和普通人的花费。生命走到尽头，谁应该为什么付钱并不明了。虽然英国人可以不用掏腰包就获得普通的医疗保健，社会福利仍然有待检验。人们必须为照护者或者养老院付钱—或者亲自照顾末期病患。在小事上经常出现纠纷，比如病患洗澡的费用该由谁承担。

A bill now trundling through Parliament would cap the cost of an individual's social care. Still, some want it to be free for those on end-of-life registries. That would cut into the government's savings—but allow more people to die as they want.

一项通过议会的议案可以覆盖个人社会福利的费用。仍有一些人希望那些生命即将走到尽头的人可以获得免费的社会福利。这将会直接减少政府储蓄—但也会让更多人以自己想要的方式告别人世。