http://www.dyingconsciously.org/death_maps.html
History
死亡紀事
Historical Traditions
歷史上的傳統習俗
Maps for the Journey of Death
死亡之旅的對照
Maps for the journey of death
from many ancient traditions reflect universal themes that transcend culture
and spirituality. The struggles, fears and concerns at the end of life are
essentially unchanging in all societies: fear of the unknown, reluctance to
leave behind loved ones, and a desire to cling to life.
對照許多古老傳統對死亡之旅的看法，反應出這個普世議題是超越文化和靈性信仰的；生命尾聲時的掙扎、恐懼和憂慮在所有的社會裡都是不變的基調：對未知的恐懼、要離開親人的抗拒和依戀生命的渴望。
Richard F. Groves
and Henriette Ann Klauser address many of these concerns in their book, The
American Book of Dying, Lessons in Healing Spiritual Pain. They draw from the lessons
found in the ancient books of the dying and offer answers to many of the
universal questions regarding death.
理察．果勒夫士（Richard F. Groves）和亨利爾特．安．克勞斯爾（Henriette Ann Klauser）在他們的著作「美國死亡書，療癒靈魂苦痛的學習」裡提到許多這類的憂慮。他們由古書裡汲取對於死亡的學習，並且對於死亡相關的普世問題提出一些解答。
Plato, one of the
greatest thinkers of all time, lived in Athens from 428 to 348 B.C. His
writings on death are extensive and include one of the earliest references to
an actual near-death experience. The context for this reference was the
story of Er, a Greek soldier who was killed in battle along with many fellow soldiers.
The bodies were collected from the battlefield and laid upon a funeral pyre to
be burned. Er awoke on top of the pyre and described what he had seen on his
journey to the realms beyond death. There he had been told that he must return
to the physical world to inform men what these other realms were like.
公元前428年到348年居住在雅典的偉大思想家柏拉圖（Plato），在他的著作裡深入探討關於死亡議題，其中還包括了歷史上最早有記載的實際瀕死經驗。記載的內容是關於一位叫做意爾(Er)的希臘士兵，他和許多同僚士兵在一場戰役中一起被殺害，他們的屍體被人從戰場上運回集中，排列在火堆上準備要火葬，意爾從火堆上醒了過來，並且向人們描述他在死後冥界之旅的見聞，在那裡他被告誡他必須回到世間來告訴人們，離開人世之後的另一個世界是什麼樣子。
Modern times have provided us with more information to create maps for the
dying process. Most near-death experiences have been reported over the last 30
to 40 years. Until the advent of modern medicine most people who had a
near-death experience did not survive—did indeed “die.” There was no
advanced resuscitation technology available until fairly recent times. Today’s
research shows almost 5% of the United States population has had a near-death
experience.
在現在的年代裡，我們被提供了更多的資訊來了解死亡的程序是怎麼回事，大部分的瀕死經驗都是在過去三十到四十年裡才被記載下來。在現代醫學發達之前，由於缺乏先進的搶救技術，大部分的瀕死經驗者並無法存活–事實上他們都真的死去了。最近的研究報告指出，在美國有將近百分之五的人有過瀕死經驗。
We can’t rely entirely on the
experiences of those who have died and been resuscitated, however, because they
usually have had such a brief journey. We must look to the earth
traditions for greater detail, such as Native Americans, Tibetans, and
Buddhists. These ancient traditions offer the best references for the
death experience—maps based on accounts of those who have journeyed to the
realms of spirit and returned to us.
然而，因為那些死而復生者的經歷往往都是那麼短暫，使得我們不能完全依賴他們的瀕死經驗；我們必須檢視全人類的傳統以找到更詳盡的資料，例如印地安土著、西藏人和佛教徒們，這些古老的傳統提供我們關於死亡經驗的最佳參考–根據那些曾經遊歷到靈界再回來的記載。
The Egyptian Book of the Dead
埃及死書
The
Egyptian Book of the Dead formed a map to negotiate the perils when passing from life through the
process of death. The maps were most often found as papyrus rolls that were
placed in the coffin beside the mummy so it would be at hand when the deceased
began his journey into the afterworld. Excerpts from The Book of the Dead are also found on tomb walls,
mummy bandages, heart scarabs and in other contexts in order to assist people
by accompanying them on their passage into the“Great Light.”
埃及死書對於人們死後的場景，如何越過死亡的嚴峻險境做了路線圖的描述，這些路線圖被記載在埃及人使用的紙莎草紙卷上，最常放在棺槨裡的木乃伊身旁，以方便亡者在開始他的冥界之旅後隨手可得。摘錄自埃及死書裡的章節，也會在墳墓的牆上、木乃伊的繃帶、聖甲蟲雕飾和其他地方被發現；其目的是在死者進入「偉大的光」之前的旅程裡，隨時提供協助。
The Egyptian Book
of the Dead was
written as inspiring poem-like prayers, bearing an incredible resemblance to
the psalms of the Hebrew Scriptures. The texts were composed during the same
time period as that of Moses and the Hebrew exodus from Egypt, acknowledging
that their cultures borrowed and adapted both language and theology from one
another. These poems were a psychological code providing a guide for how to
live as well as how to die.
埃及死書是以類似詩體文、具有啟發性的禱詞形式所撰寫的，它和希伯來舊約聖經裡的聖詩呈現著極大的相似性，它的原文是和摩西與希伯來人出埃及記的同期間所完成，這證實了在當時他們的語言與神學方面的文化，是被彼此引用和相互接納的。這些詩文都是心理學的字碼，提供了人們應該如何活著以及如何死亡的指引。
The Egyptians understood that
death to the ego and their own identity was necessary before they could face
the final “Great Death.” Therefore, little distinction was offered
between the instructions for living and instructions for dying -- the highest
value being the goal of personal integrity. Without an exemplary and moral
existence, there was no hope for a successful afterlife; one would be judged in
the afterlife on the basis of his or her deeds during life on earth.
埃及人瞭解，在他們能夠真正的面對「大死亡」之前，必須能夠先讓自己的小我和身份認同先行死去；因此，對於活著的教導與死亡的教導之間並沒有太大的差別—最崇高的價值是在於達到個人的完整為目的。如果活著的時候不能端正品格並且為人楷模，那麼想要有一個成功的來世是不可能的；人們死後是會以其在世的所做所為而被審判的。
Written over three thousand years
ago, the book contains incredible insights still relevant today: For if I
remain truthful, I am guaranteed possession over my Body and Soul. And if I
live and die in integrity, my Spirit-Soul can never be destroyed.
這本書的內容蘊含著不可思議之洞見，雖然是寫於三千年前，但是至今仍然切題：如果我保持真誠，我就被擔保可以保有我的身體和靈魂，如果我可以誠實而正直的活著和死去，我的精神靈魂就永遠不會毀壞。
The Egyptian Book of the Dead can be divided into four major
sections, focusing primarily on speculation about what happens after death. The
first section describes how the deceased enters the tomb and descends to the
underworld. The corpse of the deceased regains the physical capabilities it had
on earth, which may explain why corpses were left intact throughout Egyptian
history. In the second section, the origin of most of the important
places and gods of the beyond is explained and the deceased is reborn and made
to live again. In the third section, the deceased travels across the sky of the
underworld and appears before the judges of the dead for judgment and
vindication. In the final section, the deceased assumes his power in the
universe as of one of the gods.
埃及死書可以被劃分為四個主要的部分，主要焦點在推斷人死後會發生什麼事。第一個部分描述亡者如何進入墳墓並且下到下部世界，亡者的遺體可以重新獲得他生前的生理能力，這或許就解釋了在埃及的歷史上，為什麼死人的屍體都被完整無缺的保存下來。第二個部分則對於大部分重要的冥界地點與神祇的由來提出了解說，在那裡，亡者獲得了他們的重生。第三個部分，亡者在下部世界穿越天際旅行，出席死後的審判並為自己辯護。在最後一個部分，亡者取得了他在宇宙中應有的權利，並且成為眾神之一。
This Egyptian
version, however, unlike later books of the dead, offers little practical
advice for the physical well-being of the dying person or the bereaved family.
然而，這個埃及版的死亡之書，與之後的同類典籍不同的是，它並沒有提出太多可以使臨終者和其遺族感受到安樂的實際做法。
The Tibetan Book of the Dead
西藏渡亡經
The Bardo Thotrol, translated as the Tibetan
Book of the Dead,
teaches how one can attain heavenly realms by recognizing the enlightened realm
as opposed to being drawn into the realm of suffering. This ancient text was
passed down orally until the eighth century A.D. when it was first put into
writing. This Buddhist scripture was traditionally read aloud to guide the
dying person in recognizing the true nature of mind, untouched by change or
death, and attaining liberation. This process was referred to as the
“life-to-life Tibetan prayer wheel transition.” The spinning of a prayer wheel
is a method of prayer to purify the mind of negative karma and bring peace,
especially at the time of death. It helps transfer consciousness to the pure
land of the Compassionate Buddha.
被翻譯為西藏渡亡經的中陰聞判得渡經（The Bardo Thotro），教導我們一個人如何能夠辨識覺醒的境界，而不被招引到苦惱的世界，因而能夠到達天堂的國度。這份古老的經文經由口述一直流傳到西元第八世紀才被人以文字記載下來。傳統上，人們對臨終者大聲朗誦這本佛教經典，以引導臨終者辨識真如本性，不受死亡過程的影響並且獲得解脫。這個過程就是「西藏轉經輪渡化生命輪迴」的含意；轉動轉經輪是一種淨化人心、消除業障並且帶來平靜的祈禱方式，尤其在死亡之際，它可以轉化我們的覺知到達慈悲佛陀的淨土。
A number of passages from the Tibetan
Book of the Dead
bear an uncanny resemblance to the Chinese text, Tao Te Ching. In both cases, powerful images
are given to help neutralize the anxiety and fear that often precede death.
After we stop breathing and before the dissolution of the senses, the true
nature of mind arises -- what the Buddist refer to as the ultimate or “buddha
nature,” holding the seeds of enlightenment. If one is able to remember her
true nature in that moment preceding death, there is an opportunity to
transport consciousness to Dewachen—The Pure Lands, a place where one’s Soul
may abide and learn its remaining lessons without needing to return to a
physical body. It is the opportunity for enlightenment.
在西藏渡亡經中，有許多段落竟然和中國的道德經有著不可思議的相似性；在兩部經典裡，強而有力的影像被用來幫助消除死亡之前的焦慮和恐懼。在亡者停止呼吸之後，感官崩壞之前，真如本性在此時昇起–這就是佛教徒所稱的握著覺悟種子的結局，或叫做「佛性」。如果一個人在他死亡的前一刻可以憶起他的真如本性，那麼他就有機會覺悟而到達極樂世界–一個靈魂可以棲息與學習的淨土，在那裡，靈魂可以不必再回到俗世就可以完成其未竟的功課，這就是達到覺悟的機會。
The purpose of reading the Tibetan
Book of the Dead to the dying person was to remind her of what she had practiced in
life and as a reminder of “who we are” – already essentially perfect. Tibetan
Buddhists spend their entire lives preparing for the moment of death, studying
and going through intensive training in the meditation practices of Tonglen and
Phowa. Tonglen is a method of overcoming fear of suffering through connecting
with the suffering of others and thereby awakening inherent compassion. The
goal of Phowa is to transport one’s consciousness to merge with the wisdom mind
of the Buddha and avoid becoming seduced by lower-dimensional or negative
thinking. The practitioner guides the dying person through these meditations to
achieve liberation at the moment of death even when enlightenment was not
achieved in her lifetime.
為臨終者頌讀西藏渡亡經的目的是要提醒他保持其平日的修為，並且幫他記起「我們是誰」–既有而本然的完美。西藏的佛教徒窮其一生，研讀並經歷精深的自他相換（Tonglen）與破瓦法（Phowa，或稱遷識法）等冥想訓練，只為了死亡的這一刻作準備。自他相換是一種克服對苦難的恐懼的方法，藉由連結他人的苦難而喚醒自己與生俱來的慈悲；而破瓦法（Phowa）的目標則是不執著於個人的意識，使其與佛陀的智慧心性合而為一，因而避免受到低階或是負面的思緒所誘惑。法師藉由這些冥想教導臨終者在死亡之際得到解脫，即使在他生時並未達到覺悟之境。
If the dying person leaves the
body without transporting her consciousness, she has several days in which to
remember the practices from a preceding lifetime. However, it becomes
increasingly difficult to remember, because one is seduced by images of solace
and comfort as well as images that induce terror and revulsion. These images
are witnessed in the transition passage known as the bardo. In the bardo there
are a series of realms which correspond to all of the psychological states that
keep us attached to the illusion of separation. We fail to recognize that what
we are experiencing is not real and solid but a manifestation of mind. In each
of these realms there is an opportunity to make a choice and abandon
interaction with illusion and seek the land of love and compassion, the land of
the Buddha.
如果亡者在離開身體時依然執著於其意識，他仍有數日的時間可以回想起前世的修鍊；然而，由於個人會受到慰藉和舒適以及恐怖和反感的影像所誘惑，回憶會變得愈來愈困難。可以看見這些影像的過渡通道被稱為中陰間；在中陰間，有一系列的境界可以對應到使我們依戀分離幻象的不同的心理階段；我們無法辨認出我們正在經歷的並非真實發生，而是心智的顯化。在每一個境界裡，我們都有機會選擇停止與幻象的互動，轉而去尋求愛與慈悲的淨土，佛陀的淨土。
Until one can clear the
deeply-rooted negative habits that one harbors, one will be caught in a cycle
without end. The ideal is for the practioner to continue these practices for a
full forty days following a person’s death to offer the soul a chance to step
out of the illusions of the bardo. The soul will be reminded that nothing
negative is real and that nothing which appears to offer comfort or solace has
substance.
如果一個人不能清除根深蒂固的不良習慣，他就會一直被困在無盡的輪迴裡；法師在人死後的四十天內繼續這些法事，為的是要使靈魂有機會自中陰間的幻覺中走出來，靈魂將會被提醒，那些負面的事物都不是真實的，而那些看來舒適或欣慰的也都是虛幻的。
Celtic Books of the Dead
凱爾特族人的死亡之書
The Celtic Books of the Dead are
a series of hands-on practices rather than a book and have been passed on
through centuries of oral communication. Considered an art, these practices
sought to relieve both physical and spiritual pain at the end of life. It was
primarily through the end-of-life midwives called “anamcara” or soul friend
that the teachings were preserved and their influence extended throughout
Western Europe.
經過數百年的口耳相傳，凱爾特族人的死亡之書，雖然名為一本書，其實是一系列的實作練習講義；這些練習被視為是一種藝術，試圖減輕人們在生命尾聲時的肉體和精神上的痛苦。它最主要是透過被稱為「安南卡拉」的臨終助產士，或稱為靈魂朋友，他們保存這些教導，並且擴大影響範圍到西歐地區。
The Celts recognized
the inter-relationship of physical and spiritual suffering and taught the dying
patient – on all levels - to “lean into” pain at the end of life rather than
resisting it. The anamcara would do whatever it took to magnify the very issue
that caused suffering and help the person face it directly, thus leaving no
unfinished business.
凱爾特族人認清肉體痛苦與精神痛苦之間的關係，並且教導臨終的病人，當生命接近尾聲時，在各個不同的層次上體驗痛苦而不是抗拒它。安南卡拉會盡其所能的彰顯那個造成痛苦的問題並幫助臨終者直接面對它，使得他可以了無牽掛的離開。
The Celtic model provided unique elements of soothing medicine: harp music,
poetry and a wide range of complementary healing modalities, addressing
everything from regulating a person’s breath and diet to the content of their
dreams. The Celtic style of end-of-life care influenced much of the
Mediterranean world as far away as Spain, France and Switzerland. Monasteries
became a stronghold of palliative care and this healing modality became the
first to bear the name “hospice” at the turn of Europe’s first millennium.
凱爾特族人的這種模式為安寧緩和醫學提供了獨特的元素：豎琴音樂、詩詞和廣泛的輔助物理療法；從調節一個人的呼吸、飲食，甚至到做夢的內容，每一個細節都考慮到了。凱爾特族風格的臨終照護對於地中海區域，甚至遠及西班牙、法國和瑞士等地方都造成了極大的影響。男子修道院成為安寧照護的主要據點，在歐洲的第一個千年期，這個物理療癒法也首先獲得了「安寧照護」（hospice）的名號。
Monastic Books of the Dying
修道院的死亡之書
The Monastic Books of the
Dying is not a
distinct textbook but rather a library of records called “customaries.” These
records preserve the daily life or customs of the monasteries that housed
Europe’s earliest hospices. Written a thousand years ago, they detail an
amazing range of holistic modalities for treating the sick and dying, including
music and ritual, morphine, acupressure and aromatherapy.
與其說「修道院的死亡之書」是一本教科書，倒不如稱為是「風俗習慣」的記錄叢書。這些記錄保存了修道院士的日常生活習慣，這些修道院士維運了歐洲最早的安寧照護所。一千年前寫的這一本書，詳細敘述了整體性物理療法是如何廣泛的應用在病人和臨終者身上，其中包括了音樂、儀式、嗎啡、指壓按摩和芳香療法。
The Monastic
Books of the Dying described a unique plan of care tailored to specific needs. Nothing took
priority over supporting someone through his or her spiritual pain. The
monotheistic (belief in one god) customaries included texts and sentiments
common to all three monotheistic traditions since the Jews, Christians and
Muslims often lived and died side by side in peaceful coexistence. The
scriptures encourage the terminally ill to express a full range of emotions
from despair to anger with God, perhaps even cursing under the rubric of
prayer.
修道院的死亡之書記載了如何為特殊需求的人量身訂做不同的照護方法，沒有任何事情比協助他人渡過他心靈的痛苦更為重要了；由於猶太教徒、基督徒和回教徒在當時經常和平共處的一起生活和死亡，修道院士（信仰單一上帝）的做法包括聖經的經句以及傳承自上述三個宗教共有的修道院傳統。這個經典著作鼓勵末期病人表達其全部的情緒，從對上帝的絕望到憤怒，甚至在禮拜規程裡的禮儀指示下進行咒罵。
Gnostic Books for the Living and Dying: Bridge between the East and
West
諾斯替生死書：東方與西方的橋樑
The monastic communities from
Syria to Egypt produced the Gnostic Scriptures in the third and fourth
centuries. These scriptures, which never were accepted as part of the Bible,
are remarkably similar to Asian spiritual teachings. This is especially true
when describing how to alleviate suffering at the end of life.
在西元第三到第四世紀，敘利亞到埃及一帶的修道院士們創作了諾斯替聖典，這些聖典（並未被採納為聖經的一部分）和東方的靈性教導有著明顯的相似性，尤其在描述如何舒緩生命末期的痛苦方面更是雷同。
An early text
fragment from the Gospel According to Mary Magdalene parallels passages in the Tibetan
Book of the Dead
in describing the stages of dying and the challenges faced during the
life-to-death transition. In the gospel’s tradition, the role of the spiritual
companion to the dying person was to help her negotiate universal perils that
show up at the end of life, such as doubt in the essential goodness of one’s
nature.
西藏渡亡經中對於死亡的各個階段以及所遇到的挑戰之描述，在新約聖經抹大拉的瑪利亞福音書早期未完成的部分裡，有著相似的論述；在福音教派的傳統中，做為臨終者的精神陪伴者，其主要的角色是要幫助他順利越過生命的盡頭所普遍會出現的危機，例如對人性本善產生質疑。
Parts of the Gnostic
scriptures read like an ancient map for finding peace at the end of life,
exhorting the dying to embrace the moment and rest in the power of the present.
Consistent advice is given to face one’s mortality and embrace the
indestructible nature of spirit. Stories of contemporary near-death experiences
corroborate what our ancestors realized: the dying person faces fierce
spiritual obstacles before being able to release the spirit.
部分諾斯替教的經文讀起來，像是在引導人們在生命尾聲時尋求內心平靜的古老路線圖，規勸臨終者擁抱死亡時刻，安息於臨在的力量之中；不斷的忠告人們雖然終將一死，卻可以擁抱靈魂不滅的本質。當代許多瀕死經驗的敘述，更加證實了我們祖先們的領悟：臨終者在能夠釋放其靈魂之前，必須面對激烈的精神反抗。
? 2008 by The Four
Winds Society, Inc. All rights reserved.
http://www.dyingconsciously.org/near_death_experiences.html
Near Death Experiences
瀕死經驗
Near Death Experiences
瀕死經驗
In his groundbreaking book, Life
After Life, Dr.
Raymond Moody describes the elements common to the experiences of individuals
who have been to the “other side” and back. Reports of these near-death
experiences bear striking similarities— one being a sense of timelessness.
在雷門‧牧迪博士所創作的「生命輪迴」（Life After Life, Dr. Raymond Moody）一書中，描述那些死而復生者的共通經歷；在這些瀕死經驗報告中，可以發現顯著的相似性–感覺進入沒有時間的永恆裡。
These common elements have one theme that was repeatedly stated: the near-death
experiences were inexpressible, or that language had no words to adequately
convey what had happened. Centuries earlier Plato had gone even further,
saying not only were words inadequate in expressing these ultimate realities
but that words concealed, rather than revealed, the inner nature of things.
這些共通經歷有一個題材一直被重覆提到：瀕死經驗是難以表達的，或者說我們的語言並沒有適當的字眼可以充分的描述所發生的事情。活在幾個世紀前的柏拉圖說得更徹底，他說文字不只無法表達這些終究的事實，文字反而遮蔽了事物的內在本質，而非彰顯它。
Common elements reported by Dr. Moody
雷門‧牧迪博士所記述的共通經歷
1.
Hearing
an unusual noise—bells, wind, music, or ringing.
1. 聽到不尋常的聲響—鐘聲、風聲或是鈴聲。
2.
Moving
rapidly through a dark tunnel and seeing a light at the end.
2. 快速穿過一個黑暗的隧道並且看到盡頭有亮光。
3.
Being
outside of the physical body, but still in the immediate physical
environment. Many people also described being in a transparent or
clear form.
3. 靈魂離開身體，但是仍然停留在當前的物質環境中。許多人描述自己變成透明的形體。
4.
Being
met by others who had already died— including spirits or family members.
4. 遇見已經死亡的人—包括靈體或是家族成員
5.
Meeting
a being of light who felt like a loving warm spirit.
5. 遇見一個發散愛和溫暖的發光靈體。
6.
Going
through a life review in detail as well as a panoramic review -- evaluating
what the individual had done with her life, regrets of things she had failed to
do and re-experiencing the emotions that were associated with these events.
6. 經歷詳盡的全景式生命回顧—評價個人一生的作為，懊悔未完成的事務，並且重新經驗這些事務的情緒。
7.
Finding
a barrier or border where they could not cross and having to return home.
Many could hear or feel others calling them back; most were overwhelmed with
joy, love and peace, and did not want to return.
7. 發現一道無法跨越的障礙或是邊界，因而必須返回俗世；許多人還能夠聽到或是感到親友呼喚自己回去，大部分的人沉浸在喜樂、愛和安詳的氣氛裡，其實並不想回到人間。
8.
After
returning home, there were no words to describe the event.
8. 回到人間之後，找不到字眼可以描述所發生的事情。
All the individuals
considered life to be more precious after their experience and tried to
cultivate more love for others; this love was unique and profound. These
people also felt it was important to look at the lessons that life offered them
and to continue to seek knowledge.
所有經歷死而復生的人都覺得生命更為珍貴，並且試圖為他人培育更多的愛，獨特而深切的愛。這些人也覺得好好地檢視生命所遭遇的課題，並且持續地求知是很重要的。
Dr. Moody's findings compared to the Tibetan Tradition
雷門‧牧迪博士的發現和西藏傳統習俗的比較
Anthropologist Chris Kar
indicates that there are five elements common to modern day documentation of
near-death experience, such as Dr. Moody’s, and the Tibetan literature.
人類學家克里斯．卡爾指出，在諸如雷門．牧迪博士等人的現代瀕死經驗報告文件，和西藏文獻之間，存在有五個共同點︰
1.
Feeling
early on a great wind or roar.
1. 一開始像是在大風之中或是聽到呼嘯聲。
2.
Sensing
themselves as different and separate from their bodies or not confined by them.
2. 感覺到自己變得不一樣，與自己的身體分開，或是不受肉體的束縛。
3.
Seeing
a golden sun or clear white light.
3. 看見金色的太陽或是清澈的白光。
4.
Emerging
into the light or into the oneness.
4. 浮現在光中，或是與萬物合一。
5.
Experiencing
a detailed but panoramic view of life or a life review process.
5. 經歷詳盡而全景式的生命重演或是生命回顧程序。
? 2008 by The Four
Winds Society, Inc. All rights reserved.
http://www.dyingconsciously.org/hospice.html
End of Life Care Today
現代的臨終照護
On an average, 8 out of every 1,000 persons living today will die within the next year; worldwide,
an average of 1.76 persons dies per second. In North America, catastrophic
illnesses or accidents account for only about 20% of all fatalities; the
majority of people will die naturally, due to long-term disease or the aging
process. This gives most of us an opportunity to prepare for our own death and
for the deaths of those we love.
在今天活著的一千個人當中，平均有八個人會在一年之內死亡；以全球來看，每秒鐘會死去1.76個人；在北美洲裡，只有百分之二十的死因是突發的疾病和意外。大部分的人將會是因為長期的疾病或是老化而自然的死掉；這給了大部分的我們為自己以及親人的死亡好好準備的機會
At the same time, physicians
have more people in their waiting rooms with emotional problems than ever
before. There are more elderly patients who live alone with physical
disabilities and limitations, facing loneliness and isolation. In modern
society, death is seen as an event to be feared; we put our elderly in homes
for the aged and shield ourselves and our children from the awareness of our
own ultimate demise. There is no real understanding of death, of what happens
in the process of dying or beyond. Generally, people today are taught to deny
death and, when confronted with its inevitability, are filled with terror and
confusion.
但是在此同時，醫師有比以前更多具有情緒問題的病人在他們的等候室中等待。有更多帶著殘疾和不便的獨居年老病人，一個人與世隔絕地面對著寂寞。在現代的社會裡，死亡被當成一件令人害怕的事情，我們把年邁的長者放在老人之家，好讓自己以及小孩逃避我們自己最終將會死亡的體認。對於死亡之際或是人死之後將會發生什麼事情，我們並沒有真正的了解。整體而言，今日的人們被教導去否定死亡，即使無可逃避的遇上了，也是充滿了恐懼與困惑。
Modern medicine has made incredible technical advances in prolonging life and
providing drugs to numb pain, suffering or other discomfort. And yet, for the
most part, people are not dying well. By concentrating exclusively on the
physical aspects of caregiving, western medicine has neglected to address
patients’ spiritual and emotional needs. Many of these issues have prompted us
to search for better ways to understand and cope with the problems of death and
dying.
現代醫學開發了驚人的先進技術以延長壽命並使用藥物來麻痺疼痛、痛苦等不適；然而，大部分的人並不能好好的死去。西方的醫療方式將注意力完全集中於物質面的照顧，卻忽視了病患在精神和情緒上的需求；這方面的許多問題，激發我們去尋求更好的方式去瞭解並處理生與死的問題。
The Hospice Movement
安寧照護的變遷
The hospice movement has
changed the face of end-of-life medicine, offering an integrative approach to
complement and even take over for medical treatment when everything possible
has been done for the dying. Hospices dotted Europe’s high Alpine landscape
which followed ancient Roman trade routes; some of the oldest hospices trace
their lineage back to the year 1000 AD. The modern hospice movement came to
America about forty years ago, due to the extraordinary work of English
physician, Dame Cicely Saunders.
安寧照護的變遷已經改變了臨終醫療的面貌，它以整合性的方式與醫療互補，甚至在醫療措施無計可施之後取而代之。安寧照護所星羅棋佈在古代羅馬人經商路線的阿爾卑斯山脈上，某些最古老的安寧照護所甚至可以回溯到西元一千年的時候。經由英國醫師丹．西斯里．桑德士（Dame
Cicely Saunders）的非凡運作，現代安寧照護的變遷大約在四十年前被引入美國。
A pioneer, Dame Saunders in 1967 established St. Christopher’s Hospice
in London and challenged the perception that people had to die in agony. As a
result of her vision, the modern hospice movement came into being. A realistic
hope appeared for a future in which nobody had to die alone or with pain
untreated. A viable alternative was created for the end of life, one primarily
palliative which provided physical care while tending to the emotional
and spiritual concerns of the dying person.
做為一個先驅者，丹．桑德士於一九六七年於倫敦設立了克里斯多福安寧照護院，挑戰人們必須在痛苦中死亡的認知。由於他的遠見，現代安寧照護的變革於焉誕生。在未來人們不會孤單、痛苦的死去將是一個可以實現的希望。為臨終者所發展出來可實行的照護方法是，一方面在生理上以疼痛緩和為主，另一方面則照護臨終者在情緒上和精神上的掛念。
Dr. Elizabeth Kubler-Ross and the Stages of Grief
伊麗莎白‧庫柏勒–羅絲博士（Dr. Elizabeth Kubler-Ross）以及悲傷的各個階段
Another Pioneer who was
integral in changing the way we perceive death, as well as improving how we
die, was the physician and psychiatrist, Elisabeth Kubler-Ross. She worked
directly with dying patients, respecting them as individuals and seeking their
experiences in order to better understand the strengths and weaknesses of our
medical system. Her work helped us to realize how imminent death affects
patients, the professionals who serve them, and the patients’ families. All
involved experienced an emotional response to loss and this became the basis
for Dr. Ross’ model of “The Stages of Grief.”
談到我們對於死亡認知的改變以及我們在死亡品質上的改善，另外一位不能不提到的先驅者是醫師兼精神病學家伊麗莎白‧庫柏勒–羅絲博士（Dr. Elizabeth
Kubler-Ross），她在第一線面對臨終的患者，尊重每一個個體，並且探索他們的經驗以求更加深入了解我們醫療系統的優點與缺點。她的工作幫助我們體認到迫在眉睫的死亡是如何地影響著病患、服務病患的從業人士以及病患的家屬。所有涉入者都體驗到情緒上的波動，而這也成為羅絲博士的「悲傷的各個階段」模型的基礎。
Through her work, Dr. Kubler-Ross came to recognize that patients at the end of
life are acutely aware of the seriousness of their condition whether they have
been told or not. This allowed us to understand the importance of communicating
with the dying regarding their illness and its prognosis. When informed that
they were terminally ill, patients’ reactions were almost identical. The coping
mechanisms they experienced to deal with the loss of life, and all that such a
loss encompassed, came in five stages: denial, anger, bargaining, depression
and finally, acceptance. When patients reached the final stage of acceptance,
interference from outside caused the greatest turmoil, preventing them from
dying in peace. No matter the stage of illness or coping mechanisms used,
all the patients held on to some level of hope until the last moment.
This hope should be honored as it allows patients to maintain their spirit and
gives them the endurance they need to go through the end-of-life cycle.
經由她的工作，庫柏勒–羅絲博士逐漸了解到，生命垂危的病人，不論他們是否被告知，其實他們對於自己病況的嚴重程度都有所認知。這讓我們理解到和臨終者溝通其病情與預後的重要性（譯註：預後是指醫師對於病人未來的疾病發展情形，以及經治療後能恢復程度做出的評估）。當病患被告知已經到達末期病情之時，他們的反應幾乎都是一致的；他們面對即將失去生命以及所有的事務時所觸動的應變機制，大略分成五個階段：拒絕承認、憤怒、討價還價、沮喪和最後的接受。當病患進入了最後的接受階段，外在的干擾反而製造最大的混亂，因而讓他們無法平靜的安息而去。不論是處於那一個階段的病情或是應變機制，所有的病患一直到最後都抱持著某種期望；我們應該尊重這些期望，因為它讓病患維繫其精神，並且給予他們渡過生命尾聲所需要的耐力。
Dr. Kubler-Ross ultimately determined “though every man will attempt in
his own way to postpone questions and issues related to death, until he is
forced to face them, he will only be able to change things if he can start to
conceive of his own death. This must be achieved by every human being
alone. If each of us would make a start by contemplating the possibility
of our own personal death, we may affect many things, most important of all the
welfare of our patients, our families, and finally perhaps our nations.”
庫柏勒–羅絲博士最後結論說：「儘管每一個人在被迫面對死亡之前，都會試圖以他自己的方式拖延關於死亡的問題和議題；但是只有當他開始去設想自己的死亡時，他才有辦法改變事情，這是每一個人都必須獨自處理的事。如果我們每一個人都可以開始認真思考自己死亡的可能性，我們就可以影響許多事情，尤其是我們病患的福利，我們親人、甚至我們國家的福祉」
There have been many other significant contributors to the end-of-life care,
such as Peter Levine. A non-comprehensive list of references is given in the resource section.
另外還有許多對於臨終照護有重大貢獻的人，例如彼得‧利文（Peter Levine）等人。關於這個部分，我們在
資訊與資源這個網頁有一份簡單的書單可供參考。
? 2008 by The Four Winds Society, Inc. All rights reserved.