先週末に図書館でコピーした「芭蕉の誘惑ー嵐山光三郎」の序にあたる“芭蕉の旅は秘密だらけだ”をコチコチしながらゆっくりと読んだ。
双六の賽振り奥の細道へ(水原秋桜子)
解らない字句は二つであった。屹立(きつりつ)は読めず、意味も解らなかった。俳枕はその通りの読みであったが、意味は初めて知った。
『奥の細道』は二重三重に仕掛けられた文芸の罠があり、それを実地検証すると驚きの連続で、「ハッ」と声をあげることもたびたびであった。芭蕉は、人も句も蜃気楼のようで、近づいてつかまえたと思った瞬間に手から抜け出して、遥か奥に屹立している。
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あやしい旅は心を寄せた美青年杜国（万菊丸）との蜜月『笈の小文』である。『笈の小文』は芭蕉没後に刊行された紀行だが、芭蕉は秘密本のままにしておきたかったのではないだろうか。また、おばすて山で月見をする『更級紀行』のルートは、芭蕉ゆかりの俳枕が多く残っており、芭蕉ファンにとっては穴場である。
英文読解の方はどうしても、安楽死や尊厳死の記事に眼が停まってしまう。
NYTの以下の記事を読んで、コチコチしている。緩和医療の医師のオピニオンなので、“死ぬ権利”を尊重しながらも、なんとか身体的・精神的な苦痛を取り除き、苦痛を原因・理由とする死の選択を回避させたいと云う論調である。
このような医療施策が先進医療の一環として一層充実することを望んでおります。
自死という選択もあり青樹海(田中悦子)
死ぬならば自裁晩夏の曼珠沙華(橋本栄治)
(NYT記事)
1/2 Should I help my patients die? － by Jessica Nutik Zitter 医師による自死介助
以前読んだ書評
End-of-life care, October 4th 2014 P86 (末期介護ー書評)
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Too many old people in the developed world end their lives in hospital, hooked up to machines and surrounded by strangers. That needs to change.
Would life still be worth living if you could watch football on television and eat chocolate ice-cream, but not walk, feed yourself or use the bathroom unaided? How much pain would you accept for the chance of a few extra weeks? And how would you use the time you had left if you knew that no such chance remained?
For most people in the developed world, conversations about such topics never take place. Young people remark in passing that they would rather be dead than go into a nursing home；that they do not want to die in hospital；that do not want a drawn-out, agonising end. The closer that end is, the less it is talked about. The result is that hard choices are made without an understanding of their consequences. More and more people spend their last hours exactly as they wished not to：hooked up to machines under fluorescent lights, surrounded by strangers.
As death approaches, horizons naturally close in. Young people in peacetime say they want to travel, learn and experience things they do not know and meet new people. The elderly and those who are reminded of their mortality by war or civil upheaval want to be in familiar places and with those they love. But many people close to death are cheated of the chance to shift their focus to the near future. They find themselves admitted to hospital for what they think is a treatment that can fix them, only to be stuck there till death.
In this eloquent, moving book Atul Gawande, a general surgeon and author of other thoughtful works on the doctor's trade, explain how and why modern medicine has turned the end of life into something so horrible. “Over and over, we in medicine inflict deep gouges at the end of people's lives and then stand oblivious to the harm done,” he says. The book's focus is America, which spends vast sums on dubious end-of-life treatments. But other rich countries (and increasingly those that are not rich) are experiencing many of the same trends.
Rightly, doctors have abandoned the paternalism that used to lead them to conceal terminal prognoses. But they have failed to find a voice and the courage to guide their patients through the various treatments between which they are supposed to choose, too often hiding behind “informed consent”. That too few geriatric specialists are being trained has not helped：in America only 300 graduates every year. Meanwhile, for those people who live long enough to become frail before dying, a nursing home that puts safety before anything that might make their final days worth living awaits. “Our most cruel failure in how we treat the sick and the aged”, says Dr Gawande, “is the failure to recognise that they have priorities beyond merely being safe and living longer.”
Many passages in “Being Mortal” will bring a lump to the throat, but Dr Gawande also visits places offering a better way to manage life's end：a Jewish retirement community on the same site as a school where the residents can act as tutors；a nursing home filled with pets for patients to care for；a sheltered-housing programme that commits itself to supporting all residents, no matter how complex their needs. And Dr Gawande himself learns to have better conversations with the sick and dying. Trial and error, and guidance from enlightened colleagues, some within the hospice movement, have taught him a useful opening gambit：“I am worried.” These words signal that the latest procedure is neither a sure nor a cure, and start a discussion about priorities and outcomes, and how qualified hope should be.
Many people fear that a doctor who does not try everything possible has abandoned his patients, and they will die earlier as a result. Surprisingly, however, the try-everything approach appears not even to offer a longer life. Multiple studies have shown that patients entering hospice care, which usually means abandoning attempts at a cure, live at least as long as those receiving traditional care. A startling study in 2010 found that patients with advanced lung cancer who saw a specialst in palliative care as well as receiving the usual oncological treatment stopped chemotherapy sooner, entered a hospice earlier, suffer less - and lived 25% longer than comparable patients who received only the standard care. “If end-of-life discussions were an experimental drug, the FDA [an American regulatory body] would approve it,” says Dr Gawande. In life, as in all stories, he writes, “endings matter”.
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