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  3. Modern lore has it that in England death is imminent, in Canada inevitable and in California optional. Small wonder. Americans’

Modern lore has it that in England death is imminent, in Canada inevitable and in California optional. Small wonder. Americans’

admin2015-01-09  68
问题     Modern lore has it that in England death is imminent, in Canada inevitable and in California optional. Small wonder. Americans’ life expectancy has nearly doubled over the past century. Failing hips can be replaced,clinical depression controlled,cataracts removed in a 30-minute surgical procedure. Such advances offer the aging population a quality of life that was unimaginable when I entered medicine 50 years ago. But not even a great health-care system can cure death-and our failure to confront that reality now threatens this greatness of ours.
    Death is normal;We are genetically programmed to disintegrate and perish, even under optimal conditions. We all understand that at some level,yet as medical consumers we treat death as a problem to be solved, Shielded by third-party payers from the cost of our care,we demand everything that can possibly be done for us, even if it’s futile. The most obvious example is late-stage cancer care. A vast industry pushed for aggressive and expensive therapy for prostate cancer, despite a lack of demonstrable benefit for many patients. Physicians-frustrated by their inability to cure the disease and fearing loss of hope in the patient-too often offer aggressive treatment far beyond what is scientifically justified.
    Meanwhile, the kind of palliative care provided in hospices is taught derogatorily to medical students as a treatment of last resort. In 1950 the United States spent $ 12.7 billion,or 4.4 percent of gross domestic product, on health care. In 2002 the cost will be $ 1.54 trillion-nearly 14 percent of GDP, by far the largest percentage spent by any developed country.
    Anyone can see that this trend is unsustainable. Yet few seem willing to try to reverse it. Some ethicists conclude that a government with finite resources should simply stop paying for medical care that sustains life beyond a certain age-say 83 or so. Former Colorado governor Richard Lamm has been quoted as saying that the old and infirm "have a duty to die and get out of the way"so that younger, healthier people can realize their potential.
    I wouldn’t go that far. Not long ago similar arguments were used to justify mandatory retirement ages as young as 55 for employees in industry, academia and government. The message was "Step asidel want your desk and your paycheck." Energetic people now routinely work through their 60s and beyond, and remain dazzlingly productive. At 78,Viacom chairman Sumner Redstone jokingly claims to be 53. Supreme Court Justice Sandra Day O’Connor is in her 70s, and former surgeon general C. Everett Koop chairs an Internet start-up in his 80s. These leaders are living proof that prevention works and that we can manage the maladies that come naturally with age. As a mere 68-year-old, I aspire to age as productively as they have.
    Yet there are limits to what a society can spend in this pursuit, or should. I’ve watched as the lives of my family members and friends have been painfully prolonged. It’s a stark contrast with the inexpensive and compassionate deaths of my parents a generation ago.
    As a medical consumer, I may want Medicare to buy me multiple coronary bypass operations or a desperate round of bone-marrow transplantation. As a taxpaying citizen, I know-intellectually, if not emotionally-that the value of such measures must be weighed against other social goods,such as housing,defense and education,And as a physician,! know the most costly and dramatic measures may be ineffective and painful. I also know that people in Japan and Sweden, countries that spend far less on medical care,have achieved longer, healthier lives than We have. As a nation,we may be overfunding the quest for unlikely, cures while underfunding research on humbler therapies that could improve peoples’ lives. For example,the field of alternative and complementary medicine receives just A. 5 percent chunk of the National Institutes of Health budget.
    To create a human system of health care,We must acknowledge that death and dying are not themselves the enemies. As the post-World War II British epidemiologist Archie Cochrane once observed, cures in medicine are rare,but the need for "care"—attention and reassurance from approachable, sympathetic physicians And caregivers-is widespread. Cochrane worried that by pursuing cures at all cost, we would restrict the supply of care that patients can receive. This is precisely the crisis of contemporary medicine:billions for cures, and pennies for care. Medicine can accomplish great things for the generation now passing 50,but only if we’re wise enough not to ask too much of it.
Palliative care provided in hospices_____.
选项 A、is not thought much of because it doesn’t cure patients
B、needs much more money than health care and is unsustainable
C、is for poor people who can’t afford to stay in hospital for a long time
D、should be attached more importance
答案A
解析 细节题。将第二段的最后一句和第三段第一句连起来看“Physicians-frustrated by their inability tocure the disease and fearing loss of hope in the patient…．Meanwhile，the kind of palliative care provi-ded in hospices is taught derogatorily to medical students as a treatment of last resort．”正是由于“palliative care”不能将病人治愈才被轻视，否则就不必去追求大胆且昂贵的治疗方法。故正确答案为A。选项B和C明显错误，选项D中去掉“greater”更为合适，因为“palliative care”本身之前并未受到重视，不能说需要“得到更大的重视”。
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