最后关头你是否愿意被抢救
The man was unconscious and alone when he arrived at University of Miami Hospital last summer.
这名男子去年夏天被送到迈阿密医院的时候处于昏迷没有陪伴的状态。
He was 70 years old and gravely ill.
他已经70岁了，病得很重。
"Originally, we were told he was intoxicated," remembers Dr. Gregory Holt, an emergency room doctor, "but he didn't wake up."
“最开始，我们得知他喝醉了，”格里戈里.霍特医生回忆说，他是一名急救室的医生，“但他没有醒过来。”
"He wasn't breathing well. He had COPD. These would all make us start to resuscitate someone," says Holt.
“他呼吸不畅，患有慢性肺阻塞。这些通常都会让我们开展准备给病人进行心肺复苏，”霍特说。
"But the tattoo made it complicated."
“但他的纹身让事情变得复杂了。”
The tattoo stretched across the man's chest.
纹身横亘于他的胸前。
It said "Do Not Resuscitate."
纹身刻的是“不要做心肺复苏。”
His signature was tattooed at the end.
纹身的末尾还有他的签名。
"We were shocked," remembers Holt. "We didn't know what to do."
“我们震惊了，”霍特回忆说。“我们不知道该怎么办。”
The tattoo, and the hospital's decision about what it required of them, has set off a conversation among doctors and medical ethicists around the country about how to express one's end-of-life wishes effectively, and how policymakers can make it easier.
这个纹身和医院对其提出的要求的回应引发了全国医生和医学伦理学者们的广泛争议，大家都在讨论一个人该如何有效地表达自己的临终请求，以及决策人如何能让这件事变得更简单。
In the U.S., the standard way to tell doctors you want to be allowed to die is to sign an official form saying you don't want to be resuscitated.
在美国，告诉医生你希望迎接正常迎接死亡的标准方式是填一份正式的表格表明你不希望接受心肺复苏。
That means, among other things, you don't want doctors to do CPR or use a ventilator to keep you alive if you stop breathing.
这表示，在各种救治方法中，你不希望医生使用心肺复苏术或者当你停止呼吸后用呼吸机来维持你的生命。
But signing the official form doesn't guarantee your wishes will be followed.
但就算填了表格也不能保证你的请求就能够被遵从。
If you lose consciousness and end up in the emergency room, for example, the form may not come with you, in which case many doctors err on the side of intervening.
如果你失去意识，被送了 急救室，比如说，这份表格可能没能随你一起送到，这时医生往往倾向于错误地进行干预性抢救。
"A lot of doctors say, 'Look, you can always be dead later. Don't take a course that's irreversible,' " explains Dr. Kenneth Goodman, a longtime medical ethicist for the University of Miami hospital and the man Dr. Holt called when he saw the man's tattoo.
“很多医生都会说'瞧，你总是可以再多活一点的。不要采取这种不可逆转的方式。’肯尼斯.古德曼医生解释说，他是迈阿密大学附属医院的一名资深的医疗伦理学者，也是霍特医生看到纹身后打电话呼叫的人。
It was his job to figure out the best course of action, and quickly — the man seemed to be dying.
他的工作就是指出最好的抢救方式，并且要快—病人马上就快死了。
"Our big concern was, is this real?" remembers Holt.
“我们最担心的是，这是真实的吗？”霍特回忆说。
The only previous example they could find in the medical literature was a case from 2012, in which a man with a chest tattoo that read "D.N.R." told doctors it was the result of a drunken bet, and that it didn't reflect his wishes.
他们唯一能找到的先例是2012年时，有一名男子胸口上纹了“D.N.R.”（不要心肺复苏的缩写）但是告诉医生这是 喝酒后打的赌，不能反映他的真正想法。
And, even if this tattoo was real, it was initially unclear whether it should carry the same weight as an official form stating the same thing.
同时，就算纹身是真实意愿的表达，一开始医生们也不清楚它是否跟正式表格具有同等的效力。
"My thoughts were these," explains Goodman.“
我是这样想的”，古德曼说。
"He's gone through the trouble of getting this tattoo that says please don't do this to me, and he's probably seen it pretty frequently since then.
I suppose every time one's looking in the mirror one would see this."
“他最初经历了纹身的痛苦，纹上了不要对我心肺复苏，之后他可能也能经常看到它。我认为他可能每次照镜子都会看到。”
In that way, the tattoo might be more likely to reflect the man's current wishes than a form, which he might have signed and forgotten to update.
这样的话，纹身可能比表格更能反映他目前的 意愿，表格可能以前填的，现在已经忘了。
"If we take a piece of paper at face value even if he might have changed his mind, we really should take this tattoo at face value, even if he might have changed his mind," Goodman says.
Goodman advised the doctors to take the tattoo seriously.
古德曼建议医生们严肃对待纹身。
The man got sicker and sicker overnight.
这名男子的病一天比一天重。
They didn't do CPR.
他们没有采取心肺复苏。
The man died.
这名男子最后去世了。
And social workers eventually found the man had an out-of-hospital form on file with the Florida Department of Health that backed up his tattoo.
一名社会工作者最后发现他跟弗罗里达医疗部在医院外曾签署了一份表格，意思跟纹身一致。
Holt published a case study about the patient in The New England Journal of Medicine in November, thinking it might be helpful for other doctors.
霍特在新英国医学杂志的十一月刊上发表了这个病人的个案研究，希望能对其他的医生有所帮助。
Since then, he and Goodman say they have heard from a wide range of doctors and ethicists.
之后，他和古德曼说他们都收到了很多的医生和伦理学者的消息。
"It started a good conversation" about how to help people express their end-of-life wishes in productive ways, Holt says.
“它引发了一次很好的对话”来讨论如何帮助人们用有效的方法表达他们的临终意愿，霍特说。
Tattoos, he and Goodman both say, are not the answer.
纹身，他和古德曼都说，不是最好的办法。
Although the tattoo ultimately worked in this case, "the long and short of it is that I don't think it's a useful thingIt really gave us more pause than help," Holt says.
尽管这次案例中纹身最终起到了作用，“总而言之，我还是不认为这样有用。它让我们更多地停顿，而没有帮上忙，”霍特说。
What would really be helpful is an easy way to access official forms from everywhere.
真正管用的是让各地的人们都能方便地填好正式表格。
Ideally, EMTs and ER docs could both know instantly what care an unconscious person wants.
最理想的的状态就是，急救和急诊的医生们都能马上知道昏迷的病人们想要什么样的治疗。
"Imagine an ordinary patient who has a preference never to be resuscitated, and that is in her record," says Goodman.
“假如有一名普通病人不希望被心肺复苏抢救，这个写进她的病例记录离，”古德曼说。
"Why then, that ought to be something you can call up anywhere."
“为什么要等到最后呢，这应该是你随时随地都可以准备好的事情。”
Some states have attempted to do that by establishing electronic registries for a type of directive called a POLST form, which is meant to be used by very old or sick people.
有些国家试图达到这样的效果，他们建立了一种POLST维持生命治疗的指示电子表格，这些是为病重或者老年的人们准备的。
Oregon's registry has increased the odds that people get the care they want, and since California launched a pilot registry in 2016, some doctors say they have seen fewer patients who choose to wear their preferences on their bodies — etched in bracelets, mostly, not tattooed on their skin.
俄勒冈的登记制度让人们更有可能得到自己想要的救治，而加利福尼亚2016试点登记以来，有医生说他们看到把意愿刻在身上的病人减少了—大部分是刻在手镯上，而不是纹在皮肤上。
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