The purpose of medical schooling

was to teach how to save lives, not how to tend to their demise(死亡).

half an hour 半小時

an hour and a half

It is not death that the very old tell me they fear. It is what happens short of death—lossing?

their hearing, their memory, their best friends, their way of life.

Old age is a continuous series of losses.

Old age is not a battle. Old age is a massacre(殘榝;徹底擊敗).

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what makes life worth living when we are old and frail and unable to care for ourselves?

--Maslow：

At the bottom are our basic needs—the essentials of physiological survival (such as?

food, water, and air) and of safety (such as law, order, and stability).

Up one level are the need for love and for belonging.

Above that is our desire for growth—the opportunity to

attain personal goals, to master knowledge and skills, and

to be recognized and rewarded for our achievements.

Finally, at the top is the desire for what Maslow termed

“self-actualization”—self-fulfillment through pursuit of

moral ideals and creativity for their own sake.

Reality is more complex, though. People readily demonstrate a willingness to sacrifice?

their safety and survival for the sake of something beyond themselves, such as family,?

country, or justice. And this is regardless of age.

What’s more, our driving motivations in life, instead of remaining constant, change hugely

?over time and in ways that don’t quite fit Maslow’s classic hierarchy.

In young adulthood, people seek a life of growth and self-fulfillment, just as Maslow suggested.?

Growing up involves opening outward. We search out new experiences, wider social connections,?

and ways of putting our stamp on the world.

Studies find that as people grow older they interact with fewer people and

concentrate more on spending time with family and established friends. They focus on?

being rather than doing and on the present more than the future.

one’s personal perspective might be centrally important—a near-death experience that

radically changed her viewpoint on her own life.

★How we seek to spend our time may depend on how much time we

perceive ourselves to have.Cultural differences were not significant, either.

Perspective was all that mattered.

This simple but profound(深度的,深切的) service—to grasp a fading man’s need for everyday comforts, for companionship,

for help achieving his modest aims—is the thing that is still so devastatingly lacking more than a?

century later.

The most important finding was that it is possible to provide them with reasons to live.

Even residents with dementia so severe that they had lost the ability to grasp much of?

what was going on could experience a life with greater meaning and pleasure and satisfaction.

It is much harder to measure how much more worth people find in being alive than how many fewer

drugs they depend on or how much longer they can live.

What more is it that we need in order to feel that life is worthwhile?

The answer, perhaps, is that we all seek a cause beyond ourselves,an intrinsic(內(nèi)在的) human need.

The important thing was that, in ascribing value to the cause and seeing it as?

worth making sacrifices for, we give our lives meaning.

The individualist puts self-interest first, seeing his own

pain, pleasure, and existence as his greatest concern.

Human beings need loyalty. It does not necessarily produce happiness, and can even be painful,

but we all require devotion to something more than ourselves for our lives to be endurable.

Without it, we have only our desires to guide us, and they are fleeting(飛逝的), capricious(變幻莫測的),

?and insatiable(貪得無厭的).? They provide, ultimately, only torment.

Consider the fact that we care deeply about what happens to the world after we die.

If self-interest were the primary source of meaning in life, then it wouldn’t matter to people

if an hour after their death everyone they know were to be wiped from the face of

the earth.

We feel that such an occurence would make our lives meaningless.

★The only way death is not meaningless is to see yourself as part of something greater:

a family, a community, a society. If you don’t, mortality is only a horror. But if you

do, it is not.

Above the level of self-actualization in Maslow’s hierarchy of needs, they suggest?

the existence in people of a transcendent desire to see and help other beings achieve

their potential.

As our time winds down, we all seek comfort in simple pleasures—companionship,?

everyday routines, the taste of good food, the warmth of sunlight on our faces.

We become less interested in the rewards of achieving and accumulating, and more?

interested in the rewards of simply being. Yet while we may feel less ambitious, we

also become concerned for our legacy. And we have a deep need to identify purposes?

outside ourselves that make living feel meaningful and worthwhile.

The problem with medicine and the institutions it has spawned for the care of the sick and?

the old is not that they have had an incorrect view of what makes life significant.?

The problem is that they have had almost no view at all.

Medicine’s focus is narrow. Medical professionals concentrate on repair of health, not

sustenance of the soul.

The battle of being mortal is the battle to maintain the integrity(完整性) of one’s life—to avoid

becoming so diminished(減少的) or dissipated (消散的)or subjugated(被征服的) that who you are?

becomes disconnected? from who you were or who you want to be.

The professionals and institutions we turn to should not make it worse. But we have at last

entered an era in which an increasing number of them believe their job is not to confine?

people’s choices, in the name of safety, but to expand them, in the name of living

a worthwhile life.

a sheep in wolf’s clothing

The terror of sickness and old age is not merely the terror of the losses one is?

forced to endure but also the terror of the isolation.

As people become aware of the finitude(限制) of their life, they do not ask for much. They do not seek

more riches. They do not seek more power. They ask only to be permitted, insofar as possible,?

to keep shaping the story of their life in the world—to make choices and

sustain connections to others according to their own priorities.

profound (深奧的 深度的)

Terminally ill cancer patients who were put on a mechanical ventilator,? given electrical defibrillation?

or chest compressions, or admitted, near death, to intensive care had a substantially

worse quality of life in their last week than those who received no such interventions.

Surveys find that their top concerns include avoiding suffering, strengthening relationships with?

family and friends, being mentally aware, not being a burden on others, and achieving a

sense that their life is complete.Our system of technological medical care has utterly failed?

to meet these needs, and the cost of this failure is measured in far more than dollars.

The question therefore is not how we can afford this system’s expense. It is how we can build a

health care system that will actually help people achieve what’s most important to them at?

the end of their lives.

In the past few decades, medical science has rendered obsolete centuries of experience,tradition,?

and language about our mortality and created a new difficulty for mankind: how to die.

Sixty-three percent of doctors overestimated their patient’s survival time.