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Years ago, Charlie, a highly respected orthopedist and a mentor of mine, found a lump in his stomach. He had a surgeon explore the area, and the diagnosis was pancreatic cancer. He went home the next day, closed his practice, and never set foot in a hospital again. He focused on spending time with family and feeling as good as possible. Several months later, he died at home. He got no chemotherapy, radiation, or surgical treatment. Medicare didn’t spend much on him. It’s not a frequent topic of discussion, but doctors die, too. And they don’t die like the rest of us. What’s unusual about them is not how much treatment they get compared to most Americans, but how little. Of course, doctors don’t want to die ; they want to live. But they know enough about modern medicine to know its limits. Almost all medical professionals have seen what we call "futile care" being performed on people. That’s when doctors bring the cutting edge of technology to bear on a grievously ill person near the end of life. The patient will get cut open, perforated with tubes, hooked up to machines, and assaulted with drugs. I cannot count the number of times fellow physicians have told me, in words that vary only slightly, "Promise me if you find me like this that you’ ll kill me. " How has it come to this—that doctors administer so much care that they wouldn’t want for themselves The simple, or not-so-simple, answer is this: patients, doctors, and the system. To see how patients play a role, imagine a scenario in which someone has lost consciousness and been admitted to an emergency room, and shocked and scared family members find themselves caught up in a maze of choices. When doctors ask if they want "everything" done, they answer yes. Then the nightmare begins. Feeding into the problem are unrealistic expectations of what doctors can accomplish. For example, many people think of CPR as a reliable lifesaver when, in fact, the results are usually poor. But of course it’s not just patients making these things happen. Doctors play an enabling role, too. The trouble is that even doctors who hate to administer futile care must find a way to address the wishes of patients and families. Imagine, once again, the emergency room with those grieving family members. They do not know the doctor. Establishing trust and confidence under such circumstances is a very delicate thing. People are prepared to think the doctor is acting out of base motives, trying to save time, or money, or effort, especially if the doctor is advising against further treatment. It’s easy to find fault with both doctors and patients in such stories, but in many ways all the parties are simply victims of a larger system that encourages excessive treatment. In some unfortunate cases, doctors use the fee-for-service model to do everything they can, no matter how pointless, to make money. More commonly, though, doctors are fearful of litgation and do whatever they’re asked to avoid getting in trouble. The real problem the author is concerned about in this article is ______.
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Our daily existence is divided into two phases, as distinct as day and night. We call them work and play. We work many hours a day and we allow the necessary minimum for such activities as eating and shopping. 46) The rest we spend in various activities which are known as ecreations, an elegant word which disguises the fact that we usually do not even play in our hours of leisure, but spend them in various forms of passive enjoyment or entertainment.We need to make, therefore, a hard-and-fast distinction not only between work and play but, equally, between active play and passive entertainment. 47) It is, I suppose, the decline of active play--of amateur sport--and the enormous growth of purely receptive entertainment which have given rise to a sociological interest in the problem. If the greater part of the population, instead of indulging in sport, spend their hours of leisure "viewing" television programs, there will inevitably be a decline in health and physique. In addition, we have yet to trace the mental and moral consequences of prolonged diet of sentimental or sensational spectacles on the screen. 48) There is, if we are optimistic, the possibility that the diet is too thin and unnourishing to have much permanent effect on anybody. Nine films out of ten seem to leave absolutely no impression on the mind or imagination of those who have seen them.49) It is only when entertainment is active, participated in, practiced, that it can properly be called play, and as such it is a natural use of leisure. In that sense play stands in contrast to work, and is usually regarded as an activity that alternates with work.Work itself is not a single concept. We say quite generally that we work in order to make a living. Some of us work physically, tilling the land, minding the machines, digging the coal; others work mentally, keeping accounts, inventing machines, teaching and preaching, managing and governing. 50) There does not seem to be any factor common to all these diverse occupations, except that they consume our time, and leave us little leisure. 49) It is only when entertainment is active, participated in, practiced, that it can properly be called play, and as such it is a natural use of leisure.
Our daily existence is divided into two phases, as distinct as day and night. We call them work and play. We work many hours a day and we allow the necessary minimum for such activities as eating and shopping. 46) The rest we spend in various activities which are known as ecreations, an elegant word which disguises the fact that we usually do not even play in our hours of leisure, but spend them in various forms of passive enjoyment or entertainment.We need to make, therefore, a hard-and-fast distinction not only between work and play but, equally, between active play and passive entertainment. 47) It is, I suppose, the decline of active play--of amateur sport--and the enormous growth of purely receptive entertainment which have given rise to a sociological interest in the problem. If the greater part of the population, instead of indulging in sport, spend their hours of leisure "viewing" television programs, there will inevitably be a decline in health and physique. In addition, we have yet to trace the mental and moral consequences of prolonged diet of sentimental or sensational spectacles on the screen. 48) There is, if we are optimistic, the possibility that the diet is too thin and unnourishing to have much permanent effect on anybody. Nine films out of ten seem to leave absolutely no impression on the mind or imagination of those who have seen them.49) It is only when entertainment is active, participated in, practiced, that it can properly be called play, and as such it is a natural use of leisure. In that sense play stands in contrast to work, and is usually regarded as an activity that alternates with work.Work itself is not a single concept. We say quite generally that we work in order to make a living. Some of us work physically, tilling the land, minding the machines, digging the coal; others work mentally, keeping accounts, inventing machines, teaching and preaching, managing and governing. 50) There does not seem to be any factor common to all these diverse occupations, except that they consume our time, and leave us little leisure. 50) There does not seem to be any factor common to all these diverse occupations, except that they consume our time, and leave us little leisure.
The first two stages in the development of civilized man were probably the invention of primitive weapons and the discovery of fire, although nobody knows exactly when he acquired the use of the latter.41)______Animals have a few cries that serve as signals, but even the highest apes have not been found able to pronounce words, even with the most intensive professional instruction. The superior brain of man is apparently a necessity for the mastering of speech. When man became sufficiently intelligent, we must suppose that he gradually increased the number of cries for different purposes. It was a great day when he discovered that speech could be used for narrative. There are those who think that in this respect picture language preceded oral language. A man could draw a picture on the wall of his cave to show in which direction he had gone, or what prey he hoped to catch. 42)______Two important stages came not so long before the dawn of written history. The first was the domestication of animals; the second was agriculture. Agriculture made possible an immense increase in the number of the human species in the regions where it could be successfully practiced. 43)______44)______These inventions and discoveries—fire, speech, weapons domestic animals, agriculture, and writing made the existence of civilized communities possible. From about 3000 B. C. until the beginning of the Industrial Revolution less than two hundred years ago there was no technical advance comparable to these. During this long period man had time to become accustomed to his technique, and to develop the beliefs and political organizations appropriate to it. There was, of course, an immense extension in the area of civilized life. At first it had been confined to the Nile, the Euphrates, the Tigris, and the Indus, but at the end of the period in question it covered much the greatest part of the inhabitable globe. I do not mean to suggest that there was no technical progress during the time. 45)______Notes: ape猿。pastoral nomad 田园式的游牧部落的人。the Euphrates幼发拉底河。the Tigris 底格里斯河。 the Indus印度河。in question 所谈的(在名词后作后置定语)[A] Probably picture language and oral language developed side by side. I am inclined to think that language has been the most important single factor in the development of man.[B] Another fundamental technical advance was writing, which, like spoken language, developed out of pictures, but as soon as it had reached a certain stage, it was possible to keep records and transmit information to people who were not present when the information was given.[C] With the development of civilization, primitive people who lived in caves at that time badly needed a language, which would help them to communicate with one another.[D] The origin of language is also obscure. No doubt it began very gradually.[E] In fact, there was progress--there were even two inventions of very great importance, namely, gunpowder and the mariner’s compass--but neither of these can be compared in their revolutionary power to such things as speech and writing and agriculture.[F] These were, at first, only those in which nature fertilized the soil after each harvest. Agriculture met with violent resistance from the pastoral nomads, but the agricultural way of life prevailed in the end because of the physical comforts it provided.[G] But industry was a step in human progress to which subsequently there was nothing comparable until our own machine age. 44（）
Our daily existence is divided into two phases, as distinct as day and night. We call them work and play. We work many hours a day and we allow the necessary minimum for such activities as eating and shopping. 46) The rest we spend in various activities which are known as ecreations, an elegant word which disguises the fact that we usually do not even play in our hours of leisure, but spend them in various forms of passive enjoyment or entertainment.We need to make, therefore, a hard-and-fast distinction not only between work and play but, equally, between active play and passive entertainment. 47) It is, I suppose, the decline of active play--of amateur sport--and the enormous growth of purely receptive entertainment which have given rise to a sociological interest in the problem. If the greater part of the population, instead of indulging in sport, spend their hours of leisure "viewing" television programs, there will inevitably be a decline in health and physique. In addition, we have yet to trace the mental and moral consequences of prolonged diet of sentimental or sensational spectacles on the screen. 48) There is, if we are optimistic, the possibility that the diet is too thin and unnourishing to have much permanent effect on anybody. Nine films out of ten seem to leave absolutely no impression on the mind or imagination of those who have seen them.49) It is only when entertainment is active, participated in, practiced, that it can properly be called play, and as such it is a natural use of leisure. In that sense play stands in contrast to work, and is usually regarded as an activity that alternates with work.Work itself is not a single concept. We say quite generally that we work in order to make a living. Some of us work physically, tilling the land, minding the machines, digging the coal; others work mentally, keeping accounts, inventing machines, teaching and preaching, managing and governing. 50) There does not seem to be any factor common to all these diverse occupations, except that they consume our time, and leave us little leisure. 48) There is, if we are optimistic, the possibility that the diet is too thin and unnourishing to have much permanent effect on anybody.
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