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On Friday the UK parliament will vote on whether terminally ill individuals with mental capacity can ask for medical help to hasten death. If the assisted dying bill passes, the country will move closer towards sanctioning state-assisted suicide, bringing it in line with countries such as Switzerland, Belgium and Canada.
周五，英国议会将投票决定是否允许精神健全的绝症患者寻求医疗辅助来提早死亡。如果辅助死亡法案获得通过，英国将离批准国家辅助的自杀更近一步，跟瑞士、比利时和加拿大等国家实现同步。
There are compelling arguments on both sides of this emotive issue and the result feels impossible to call. While public opinion broadly supports change, parliamentarians seem more divided.
在这个容易触发情绪的议题上，正反双方都有令人信服的论点，投票结果似乎难以预料。虽然公众舆论普遍支持变革，但议员们之间的分歧似乎更大。
But one aspect has been overlooked: the science of predicting survival. As a safeguard, the bill restricts the right to assisted dying to those with less than six months to live. While ballpark estimates of survival can be calculated using patient groups, forecasts for individuals are harder to pin down.
但有一个方面被忽视了：预测人还能活多久的科学。为保险起见，该法案将辅助死亡的对象限制为剩余寿命不足6个月的人。虽然患者群体的大致存活时间可以估算，但预测某一个患者的大致存活时间却很难。
第一，学习terminal的用法。这个词做形容词，表示a terminal illness cannot be cured, and causes death，〔疾病〕晚期的，不治的，例：terminal cancer 晚期癌症
第二，学习compelling reason/argument/case etc的用法。这个词组表示an argument etc that makes you feel certain that something is true or that you must do something about it，令人信服的理由/论点/论据等，例：Lucy had no compelling reason to go into town. 露西没有充分的理由去镇上。
第三，学习pin down的用法。这个词组表示to understand something clearly or be able to describe it exactly，清楚地知道，确切地描述，确定，常用搭配为hard / difficult to pin down，例：The flavour was hard to pin down. 那味道很难确切描述。
“My research demonstrates that there is no reliable way to identify patients with less than six, or twelve, months to live . . . at least, no method that would be reliable enough to act as any sort of ‘safeguard’ for the proposed assisted dying legislation,” Paddy Stone, emeritus professor and former head of the Marie Curie palliative care research department at University College London, told me this week.
伦敦大学学院(University College London)玛丽•居里姑息治疗研究部(Marie Curie palliative care research department)前负责人、荣休教授帕迪•斯通(Paddy Stone)本周告诉我：“我的研究表明，没有可靠的方法能确定哪些患者剩余寿命不足6个月或12个月……至少可以说没有一种方法可靠到可以为拟议中的辅助死亡立法充当任何形式的‘保险’。”
According to Nicola White, a senior research fellow in the same unit, health professionals are no more able to offer accurate timelines of survival today than they were 30 years ago, even with the aid of additional markers like blood tests. While forecasting survival for cancer patients is fraught enough, it is even tougher with heart failure and neurodegenerative disease. These important challenges — accurately predicting an individual’s survival and deciding what counts as a terminal illness — have been overshadowed by other issues, such as the role that judges will play.
据同一部门的高级研究员妮古拉•怀特(Nicola White)说，即便有验血等额外指标的帮助，但如今的医疗工作者准确预测患者还能活多久的能力并不比30年前的同行强。虽然预测癌症患者的剩余寿命已经够困难的了，但预测心力衰竭和神经退化性疾病患者的剩余寿命就更困难了。准确地预测一个人的剩余寿命和判定哪些疾病算绝症都是重要的难题，但还有其他更突出的问题，比如法官将扮演的角色。
Predicting survival is like weather forecasting: the closer a patient comes to the end of life, especially the last 24 hours, the easier it becomes to estimate prognosis. Forecasting the last seven days of life is harder than the final 24 hours; further out than that, things become shakier still.
预测人的剩余寿命就像预测天气：患者越是接近生命的终点，尤其是在最后24小时，就越容易估计预后。预测生命最后的7天比预测生命最后的24小时更难；距离生命的终点7天以上，就很难预测了。
第一，学习fraught with problems/difficulties/danger etc的用法。这个词组表示full of problems etc，充满问题/困难/危险等，例：Their marriage has been fraught with difficulties. 他们的婚姻困难重重。
第二，学习overshadow的用法。这个词做及物动词，表示to make someone or something else seem less important，使〔别的人或事〕显得较不重要，使相形见绌[黯然失色]，例：Her interest in politics began to overshadow her desire to be a poet. 她对政治的兴趣开始盖过了想当诗人的愿望。
第三，学习prognosis的用法。这个词做名词，表示a doctor’s opinion of how an illness or disease will develop，预后，预断〔医生对于病情如何发展的预测〕，常用搭配为good / poor prognosis，例：Doctors said Blake’s long-term prognosis is good. 医生们说布莱克的远期预后良好。
To test accuracy, studies sometimes ask doctors to say whether a patient nearing the end of life has “days”, “weeks”, or “months” left. One 2023 paper covering about 98,000 patients showed that clinicians were 74 per cent accurate in judging who would live for less than 14 days and 83 per cent accurate on who would survive more than a year. But that fell to 32 per cent when estimating those in the middle, likely to live “weeks” or “months”.
为了测试准确性，相关研究有时会让医生预测一个接近生命终点的病人还剩下“几天”、“几周”还是“几个月”可活。2023年一篇涉及约9.8万名患者的论文显示，医生判断哪些患者只剩下不到14天生命的准确率为74%，判断哪些患者还能活一年以上的准确率为83%。但对于介于两者之间、还能活“几周”或“几个月”的那些患者，医生判断的准确率降至32%。
“All the studies from this country and others show that estimating [whether a patient has] six months left to live is extremely difficult and not that accurate,” says Irene Higginson, professor of palliative care and policy at King’s College London and scientific director of the charity Cicely Saunders International. “The science isn’t that well developed and I’m not sure it could be, because individuals vary so much.” Higginson declined to offer her opinion on the bill.
“来自这个国家和其他国家的所有研究都表明，对（病人是不是）还能活6个月进行预估是极其困难的，也不那么准确。”伦敦国王学院(King's College London)姑息治疗和政策问题教授、慈善机构西塞莉•桑德斯国际(Cicely Saunders International)的科学主管艾琳•希金森(Irene Higginson)说，“这方面的科学发展还不够，我也不确定这是不是科学能做到的事情，因为个体差异太大了。”希金森拒绝就该法案发表意见。
Many palliative care professionals fear that assisted dying will suck resources away from end-of-life care. Last month, the Association for Palliative Medicine voiced opposition because of concerns about protections for the vulnerable; inadequate provision of end-of-life care services across the UK; and the impact on trust between doctor and patient. Higginson points out that palliative care already includes the right for patients to refuse medical treatment.
许多姑息治疗领域的专业人士担心，辅助死亡会分走临终关怀的资源。上个月，姑息医学协会(Association for Palliative Medicine)表达了反对意见，因为担心对弱者的保护不足、英国各地临终关怀服务不足以及影响医患之间的信任。希金森指出，姑息治疗已经包含了病人拒绝治疗的权利。
第一，学习palliative的用法。这个词做名词，表示something done to make a bad situation seem better, but which does not solve the problem，权宜之计，治标不治本的方法，例：short-term economic palliatives 经济上短期的权宜之计
第二，学习suck的熟词僻义。这个词做及物动词，表示to pull someone or something with great power and force into or out of a particular place，〔以强大的力量〕抽，吸；吞没，把……卷入，常用搭配为suck sth into sth，例：A bird was sucked into one of the jet’s engines. 有只鸟被吸进喷气式飞机的一个引擎里。
Opponents wave at other countries as proof of a slippery slope: Belgium and the Netherlands now permit euthanasia for under-18s; in Canada, the lonely and the homeless have asked to die. One Toronto university psychiatrist described the country’s “medical assistance in dying” legislation as a “bait and switch”, with a well-intentioned law “metastasising” into something malign.
反对者还以其他国家为例，证明辅助死亡法案容易失控：比利时和荷兰现在允许18岁以下未成年人选择安乐死；在加拿大，有孤独者和无家可归者要求获得死亡辅助。一位多伦多大学(Toronto University)的精神病学家称该国的“医学辅助死亡”具有“欺骗性”，原本善意的法律“变形”成了某种邪恶的东西。
Those who champion assisted dying do have good intentions. They cite patient autonomy and human rights. They argue that a good death should not be restricted to those able to afford a trip to Dignitas.
确实，支持辅助死亡的人出于良好的意愿。他们提出患者有自主权和人权。他们主张，去不起Dignitas（位于瑞士的安乐死机构）的人也有权利获得善终。
The point of this column, though, is not to argue for or against the assisted dying bill — but to ask whether the science underpinning one safeguard delivers what is asked of it. The answer? Possibly not. Ultimately, parliamentarians might regard the scientific uncertainty in survival prediction, among other difficulties, as a trifling consideration when set against the opportunity to deliver liberalising reform and patient choice.
然而，本专栏的重点不是支持或反对辅助死亡法案，而是要提出一个问题：科学能不能为该法案提供它想要的“保险”？答案可能是否定的。最终，议员们可能会认为，相较于变革可能带来的解放和赋予患者的选择权，科学无法准确预测人的剩余寿命以及其他种种困难，都是微不足道的。
And that’s the point, really: this profoundly important vote should be an informed one.
而真正重要的就是这个：这么重要的投票应该在掌握完整信息的情况下进行。
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