Look, I had second thoughts, really,

皆さんのような元気な人達を前に

about whether I could talk about this

こんな話をしてもいいものか

to such a vital and alive audience as you guys.

グロリア・スタイネムの 言葉です

Then I remembered the quote from Gloria Steinem,

グロリア・スタイネムの 言葉です

which goes,

「真実は貴方を解放する

"The truth will set you free,

しかし その前に まず貴方を怒らせるだろう」

but first it will piss you off." (Laughter)

ということで（笑）

So -- (Laughter)

それを念頭において お話しするのは

So with that in mind, I'm going to set about

それを念頭において お話しするのは

trying to do those things here,

21世紀の死です

and talk about dying in the 21st century.

腹の立つ真実の一つ目は

Now the first thing that will piss you off, undoubtedly,

私達はみんな21世紀中に

is that all of us are, in fact, going to die

死ぬこと

in the 21st century.

例外はありません

There will be no exceptions to that.

調査によると８人に一人は

There are, apparently, about one in eight of you

不死身だと思っていますが

who think you're immortal, on surveys, but --

（笑）

(Laughter)

残念ながら そういう訳には行きません

Unfortunately, that isn't going to happen.

今から10分間 私が話す間にも

While I give this talk, in the next 10 minutes,

１億もの細胞が死んでいき

a hundred million of my cells will die,

今日中に２千の脳細胞が

and over the course of today, 2,000 of my brain cells

死んでしまうので

will die and never come back,

死の過程は早くから 始まると言えます

so you could argue that the dying process

死の過程は早くから 始まると言えます

starts pretty early in the piece.

21世紀の死について ２つ目は

Anyway, the second thing I want to say about dying in the

死は不可避である上に

21st century, apart from it's going to happen to everybody,

やや悲惨な様相を 呈していることです

is it's shaping up to be a bit of a train wreck

やや悲惨な様相を 呈していることです

for most of us,

容赦ない軌道に乗っている 死の過程を

unless we do something to try and reclaim this process

改善しなければならない

from the rather inexorable trajectory that it's currently on.

それが真実です

So there you go. That's the truth.

頭には来ますが

No doubt that will piss you off, and now let's see

自由にはなれるでしょうか

whether we can set you free. I don't promise anything.

集中治療が私の仕事です

Now, as you heard in the intro, I work in intensive care,

集中治療の全盛期を経験しました

and I think I've kind of lived through the heyday

色々なことがあって

of intensive care. It's been a ride, man.

最高でした

This has been fantastic.

モニターとか音の鳴る機械が

We have machines that go ping.

たくさんある職場です

There's many of them up there.

すごい技術のおかげで

And we have some wizard technology which I think

私が働き始めてから

has worked really well, and over the course of the time

オーストラリア男性の死亡率が

I've worked in intensive care, the death rate

半減しました

for males in Australia has halved,

集中治療の成果です

and intensive care has had something to do with that.

さまざまな技術を駆使した

Certainly, a lot of the technologies that we use

おかげでもあります

have got something to do with that.

大変な成功を収めて

So we have had tremendous success, and we kind of

すっかり浮かれてしまい

got caught up in our own success quite a bit,

「救命」などという言葉を 使い始めてしまいました

and we started using expressions like "lifesaving."

誤解を招いたことを

I really apologize to everybody for doing that,

お詫びします

because obviously, we don't.

私達がするのは延命で

What we do is prolong people's lives,

死を先延ばしにし

and delay death,

遠回りさせる事は出来ても

and redirect death, but we can't, strictly speaking,

永続的な救命は できないのです

save lives on any sort of permanent basis.

集中治療で働いていて

And what's really happened over the period of time

目の当たりにしていることですが

that I've been working in intensive care is that

70年代から90年代にかけて

the people whose lives we started saving back in the '70s,

私達が命を救った人達は 21世紀になって

'80s, and '90s, are now coming to die in the 21st century

当時とは違う 解決策のない病気で

of diseases that we no longer have the answers to

死んでいこうとしています

in quite the way we did then.

人の死に方に 大きな変化が

So what's happening now is there's been a big shift

起きているのです

in the way that people die,

現在の死因の多くは

and most of what they're dying of now isn't as amenable

80年代や90年代のように

to what we can do as what it used to be like

治療が可能なものではありません

when I was doing this in the '80s and '90s.

この対応に追われていて

So we kind of got a bit caught up with this,

いま何が起こっているのか

and we haven't really squared with you guys about

きちんと説明していませんでした

what's really happening now, and it's about time we did.

90年代後半にこの人に出会って

I kind of woke up to this bit in the late '90s

目が覚めました

when I met this guy.

彼の名前は ジム・スミスといいます

This guy is called Jim, Jim Smith, and he looked like this.

細い方が彼の手です

I was called down to the ward to see him.

彼の様子を見るよう

His is the little hand.

呼吸科医に

I was called down to the ward to see him

呼ばれました

by a respiratory physician.

「肺炎に罹った患者がいる

He said, "Look, there's a guy down here.

「肺炎に罹った患者がいる

He's got pneumonia,

集中治療が必要だ

and he looks like he needs intensive care.

娘さんは あらゆる手を

His daughter's here and she wants everything possible

尽くしてくれと言っている」

to be done."

私達には聞き慣れた言葉です

Which is a familiar phrase to us.

病室に様子を見に行くと

So I go down to the ward and see Jim,

皮膚が透けて

and his skin his translucent like this.

骨が見えるほどです

You can see his bones through the skin.

やせ細って

He's very, very thin,

重度の肺炎に罹っていました

and he is, indeed, very sick with pneumonia,

話は無理なので

and he's too sick to talk to me,

娘のキャスリーンに向かって こう聞きました

so I talk to his daughter Kathleen, and I say to her,

「こういう状況になった時

"Did you and Jim ever talk about

どうしたいのか

what you would want done

話し合ったことは？」

if he ended up in this kind of situation?"

彼女は私を見て 「ある訳ないでしょう！」

And she looked at me and said, "No, of course not!"

「落ち着かせなきゃ」と思いました

I thought, "Okay. Take this steady."

しばらくして 彼女はこう言いました

And I got talking to her, and after a while, she said to me,

「まだ先のことだと思ってた」

"You know, we always thought there'd be time."

ジムは94歳でした （笑）

Jim was 94. (Laughter)

それで気づきました 何かが欠けている

And I realized that something wasn't happening here.

あるはずの

There wasn't this dialogue going on

対話が持たれていない

that I imagined was happening.

そこで調査を始めて

So a group of us started doing survey work,

ニューカッスル周辺の

and we looked at four and a half thousand nursing home

養護施設に住む 4,500人に当たりました

residents in Newcastle, in the Newcastle area,

心停止の際のプランがあるのは

and discovered that only one in a hundred of them

100人のうち１人だけでした

had a plan about what to do when their hearts stopped beating.

100人中１人ですよ

One in a hundred.

重体になった際 どうするか考えている人は

And only one in 500 of them had plan about what to do

500人中たったの１人だけ

if they became seriously ill.

この対話は社会全般では

And I realized, of course, this dialogue

全くなされていない と気がつきました

is definitely not occurring in the public at large.

現職は救急医療です

Now, I work in acute care.

ジョン・ハンター病院です

This is John Hunter Hospital.

我々の病院ではこんなはずではないと

And I thought, surely, we do better than that.

同僚のリサ・ショウと一緒に

So a colleague of mine from nursing called Lisa Shaw and I

何百もの診療記録を

went through hundreds and hundreds of sets of notes

調べました

in the medical records department

受けている治療が効かず

looking at whether there was any sign at all

死ぬ可能性がある場合

that anybody had had any conversation about

患者の希望を話し合ったような

what might happen to them if the treatment they were

会話の記録を探しましたが

receiving was unsuccessful to the point that they would die.

医師や患者が始めた記録の どこにも

And we didn't find a single record of any preference

目標や治療や成果についての

about goals, treatments or outcomes from any

希望は一つも 書いてありませんでした

of the sets of notes initiated by a doctor or by a patient.

これは問題だと

So we started to realize

やっと気づきました

that we had a problem,

問題は更に深刻です というのも

and the problem is more serious because of this.

誰でも死ぬ事は知っていますが

What we know is that obviously we are all going to die,

死に方も大切だからです

but how we die is actually really important,

本人だけでなく　 先立たれた人達の

obviously not just to us, but also to how that

人生にも影響するからです

features in the lives of all the people who live on afterwards.

残された人達の心に

How we die lives on in the minds of everybody

死に様が生き続けるのです

who survives us, and

死による 家族のストレスは甚大で

the stress created in families by dying is enormous,

集中治療室で死ぬ場合のストレスは

and in fact you get seven times as much stress by dying

他で死ぬ場合の７倍です

in intensive care as by dying just about anywhere else,

選べるなら 集中治療室では

so dying in intensive care is not your top option

死なない方がいい

if you've got a choice.

ところが残念ながら

And, if that wasn't bad enough, of course,

集中治療室で死ぬ人は 急速に増えていて

all of this is rapidly progressing towards the fact that

10人に一人は集中治療室で

many of you, in fact, about one in 10 of you at this point,

死ぬことになりそうです

will die in intensive care.

アメリカでは

In the U.S., it's one in five.

５人に一人 マイアミは５人に３人

In Miami, it's three out of five people die in intensive care.

そういう勢いです

So this is the sort of momentum

これが現状です

that we've got at the moment.

その理由はこれです

The reason why this is all happening is due to this,

説明しましょう

and I do have to take you through what this is about.

４つの死に方です

These are the four ways to go.

誰もがこの一つで死にます

So one of these will happen to all of us.

よくご存知なのは

The ones you may know most about are the ones

その重要性が 過去のものとなりつつある

that are becoming increasingly of historical interest:

突然死でしょう

sudden death.

ここにいる位の人数だと

It's quite likely in an audience this size

突然死する人はいません

this won't happen to anybody here.

突然死は稀になりました

Sudden death has become very rare.

悲劇のヒロインのような死は

The death of Little Nell and Cordelia and all that sort of stuff

もう起きません

just doesn't happen anymore.

この末期疾患の

The dying process of those with terminal illness

死に方は

that we've just seen

若い人に多く

occurs to younger people.

80歳以上では少ないです

By the time you've reached 80, this is unlikely to happen to you.

80歳以上で癌で死ぬのは 10人に一人だけ

Only one in 10 people who are over 80 will die of cancer.

大幅に増加している 死因はこちらです

The big growth industry are these.

臓器不全で死ぬ人が増えています

What you die of is increasing organ failure,

呼吸器 心臓 腎臓など

with your respiratory, cardiac, renal,

臓器の機能が止まったら

whatever organs packing up. Each of these

救急病院に入院です

would be an admission to an acute care hospital,

そして もう十分だと言われるまで

at the end of which, or at some point during which,

治療を続けます

somebody says, enough is enough, and we stop.

そして これが最大の成長分野

And this one's the biggest growth industry of all,

今日お集まりの10人中６人は

and at least six out of 10 of the people in this room

これが理由で死にます

will die in this form, which is

衰弱がひどくなることに伴う

the dwindling of capacity

身体能力の衰えです

with increasing frailty,

衰えは老化において 避けられませんが

and frailty's an inevitable part of aging,

だんだん衰弱することが

and increasing frailty is in fact the main thing

現代人の主な死因です

that people die of now,

残念ながら晩年は

and the last few years, or the last year of your life

かなりの障害をもって 過ごすことになります

is spent with a great deal of disability, unfortunately.

楽しんでます？（笑）

Enjoying it so far? (Laughs)

（笑）

(Laughter)

悲劇の預言者みたいな気分だ

Sorry, I just feel such a, I feel such a Cassandra here.

（笑）

(Laughter)

明るい話をしましょう

What can I say that's positive? What's positive is

衰弱するほど高齢まで

that this is happening at very great age, now.

長生きする人が多いということです

We are all, most of us, living to reach this point.

昔は違いました

You know, historically, we didn't do that.

長生きすれば

This is what happens to you

こういう死に方になるのです

when you live to be a great age,

延びるのは老年期だけで

and unfortunately, increasing longevity does mean

若年期は増えません

more old age, not more youth.

残念な事ですが（笑）

I'm sorry to say that. (Laughter)

私たち病院などの関係者は

What we did, anyway, look, what we did,

死についての問題を

we didn't just take this lying down

見過ごしませんでした

at John Hunter Hospital and elsewhere.

不測の事態の備えに

We've started a whole series of projects

もっと関わってもらおうと

to try and look about whether we could, in fact, involve

一連のプロジェクトを 始めました

people much more in the way that things happen to them.

もちろん

But we realized, of course, that we are dealing

文化上の問題も承知でした

with cultural issues,

クリムトの絵です

and this is, I love this Klimt painting,

よく見ると 本質的なことが

because the more you look at it, the more you kind of get

描かれています つまり―

the whole issue that's going on here,

生と死は はっきり分かれるということ

which is clearly the separation of death from the living,

そして恐怖

and the fear — Like, if you actually look,

目を開けた

there's one woman there

女性がいます

who has her eyes open.

死神は彼女を

She's the one he's looking at,

狙っています 見えますか？

and [she's] the one he's coming for. Can you see that?

彼女は怯えている

She looks terrified.

素晴らしい絵です

It's an amazing picture.

ともかく文化上の理由で

Anyway, we had a major cultural issue.

人は死の話を聞きたがらない

Clearly, people didn't want us to talk about death,

そう予想しました

or, we thought that.

そこで政府と公共医療機関から

So with loads of funding from the Federal Government

予算をもらい

and the local Health Service, we introduced a thing

我々の病院で 事前ケア計画を導入しました

at John Hunter called Respecting Patient Choices.

研修を受けた数百人が

We trained hundreds of people to go to the wards

病棟を訪ね 患者たちに死の話をして

and talk to people about the fact that they would die,

終末期の希望を聞きました

and what would they prefer under those circumstances.

患者も家族も大変喜びました

They loved it. The families and the patients, they loved it.

98％がこれを 普通の診療として

Ninety-eight percent of people really thought

あるべき形と

this just should have been normal practice,

思ってくれました

and that this is how things should work.

伝えられた希望は

And when they expressed wishes,

全て叶いました

all of those wishes came true, as it were.

実現できたのです

We were able to make that happen for them.

しかし予算が底をつき

But then, when the funding ran out,

半年後に確認したら

we went back to look six months later,

打ち切りになっていました

and everybody had stopped again,

誰もこの対話をしなくなり

and nobody was having these conversations anymore.

とても残念なことでした