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  3. Death is a difficult subject for anyone, but Americans want to talk about it less than most. They have a cultural expectation th

Death is a difficult subject for anyone, but Americans want to talk about it less than most. They have a cultural expectation th

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问题     Death is a difficult subject for anyone, but Americans want to talk about it less than most. They have a cultural expectation that whatever may be wrong with them, it can be fixed with the right treatment, and if the first doctor does not offer it they may seek a second, third or fourth opinion. Legal action is a constant threat, so even if a patient is very ill and likely to die, doctors and hospitals will still persist with aggressive treatment, paid for by the insurer or, for the elderly, by Medicare. That is one reason why America spends 18% of its GDP on health care, the highest proportion in the world.
    That does not mean that Americans are getting the world’s best health care. For the past 20 years doctors at the Dartmouth Institute for Health Policy and Clinical Practice have been compiling the "Dartmouth Atlas of Health Care" , using Medicare data to compare health-spending patterns in different regions and institutions. They find that average costs per patient during the last two years of life in some regions can be almost twice as high as in others, yet patients in the high-spending areas do not survive any longer or enjoy better health as a result.
    Ira Byock is the director of palliative medicine at Dartmouth-Hitchcock Medical Centre. His book is a plea for those near the end of their life to be treated more like individuals and less like medical cases on which all available technology must be let loose. With two decades’ experience in the field, he makes a good case for sometimes leaving well alone and helping people to die gently if that is what they want.
    That does not include assisted suicide, which he opposes. But it does include providing enough pain relief to make patients comfortable, co-coordinating their treatment among the different specialists, keeping them informed, having enough staff on hand to see to their needs, making arrangements for them to be cared for at home where possible—and not officiously keeping them alive when there is no hope.
    But it is not easy to decide when to stop making every effort to save someone’s life and allow them to die gently. The book quotes the case of one HIV-positive young man who was acutely ill with multiple infections. He spent over four months in hospital, much of the time on a ventilator, and had countless tests, scans and other interventions. The total bill came to over $ lm. He came close to death many times, but eventually pulled through and has now returned to a normal life. It is an uplifting story, but such an outcome is very rare.
    Dr Byock’s writing style is not everybody’s cup of tea, but he is surely right to suggest better management of a problem that can only get worse. As life expectancy keeps on rising, so will the proportion of old people in the population. And with 75m American baby-boomers now on the threshold of retirement, there is a limit to what the country can afford to spend to keep them going on and on.
In the author’s opinion, the example of the HIV-positive young man in Paragraph 5______.
选项 A、eliminates the possibility of applying gentle dying process in medicare
B、is merely an extreme case that should not be taken as a standard
C、emphasizes the importance of aggressive treatment even with slim hope
D、is used as an irony of the current state of American medical system
答案B
解析 在第三段和第四段中，伊拉.比约克提出了姑息疗法的必要性。但在第五段第一句话中作者提出了这样一个问题，“究竟什么时候采取姑息疗法，什么时候放弃挽救病人的努力，这是一个很难把握的问题”。伊拉.比约克在书中举了这样一个例子：从前，有一位青年人身患艾滋病，病情危急，而且还感染了多种并发症。他在医院里度过了四个多月，一次次濒临死亡，但是最终却挺了过来，现在过上了正常人的生活。这样的事例表面是对姑息疗法的反驳，但是在第五段最后一句话中作者明确表达了对于这样的事例的观点，“It is an uplifting story，but such an outcome is very rare．”这是一种很极端的情况，我们不能因为存在这样的个别案例就全盘推翻姑息疗法的提议。因此，本题的正确答案应该选[B]。
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