Do not “Do Not Resuscitate”?

Posted on January 13, 2011 at 12:17 am

You may have noticed our recent piece about having one of the toughest conversations we have in life – how we would prefer to die.

It’s probably always going to be awkward to some degree, but we’ve found that if you give people a way to elegantly broach the topic – such as offering up a story from the news, or a sheet of paper that has a couple thought-provoking questions on it – they’re more open to the idea.

So we read with interest a recent article in the New York Times reporting that a document we use to talk about end-of-life planning – the Do Not Resuscitate or D.N.R. order – might be better referred to as an A.N.D. order, for “allow natural death.”

Many folks in the medical community suggest it would be less stressful – yet just as impactful – for someone to sign the more positive-sounding A.N.D. for themselves or on behalf of their loved one, even if the subsequent medical actions were exactly the same, with the patient receiving comfort care to relieve pain but not undergoing cardiopulmonary resuscitation.

In short, just the way it’s phrased might impact whether and how these tough choices are made.

And that means that there would potentially be fewer of the kinds of painful and prolonged endings that so many of us have seen loved ones suffer. Many of the comments on the article reflect this reality:

“The case of my stepmother, who was dying of lung cancer, especially supports the idea of a name change: she simply could not bring herself to sign a D.N.R.–it seemed too much like giving up–and after she could no longer make the decision for herself, my frail elderly father couldn’t bring himself to make that decision for her. As a result, rather than slipping away gently, she went through an awful resuscitation that blocked the opiates that were preventing horrific pain due to spinal metastases of her lung cancer. She lived an additional week, most of it in that horrific pain, because it took that long to bring the pain back under control. I believe that my poor father would have been more likely to “Allow Normal Death” than to withhold resuscitation from his beloved wife.”

“Signing a DNR was painful for my family when my mother was hospitalized. It felt very sad, like we were signing a death warrant. I think changing the wording would alleviate this pain. Some might call it just a positive spin, but if you ask someone whether they’d prefer to “die a natural death” or “not be resuscitated,” I suggest most would go with the former, even if they both mean the same thing in the end.”

It’s that positive spin that we believe helps more people make tough decisions about their health, as we’ve touched on in many of our posts. And those of us who are parents try to do this all the time – guiding our kids to what they SHOULD do, rather than saying “no, no, no”.

So in the case of end-of-life planning especially, this notion of an A.N.D. order represents the shift from giving up to the far more empowering saying what you want.

Of course you could argue that an A.N.D. order may be less specific in its direction than a D.N.R. Or that it’s just a tiny sliver of the larger conversation we should all be having about end of life planning. And of course you should argue that everyone has every right to choose the opposite of what both of those documents stand for, either for themselves or for their loved ones.

But our point is that by reframing the notion in a way that sounds less tragic, it may make it easier to approach these conversations in the first place, when we are well. And then it leaves us less wracked with guilt and more likely to be rewarded with the feeling that we made the best decision we could possibly make when the time comes.

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  • Alvaro Escorcia April 28, 2011 at 8:14 am

    There should be a way to sign a “conditional” A.N.D. statement. For example subject to a medical prognosis of high level of suffering, astronomical cost, and low probability of full recovery. Someone could recommend how to make this practical for implementation. If i see something like this, I would probably sing it (and use it to get a good discount on insurance fees, and / or reduction on insurance deductible). Cost of healthcare is affecting all of us.