No one likes to talk about death, but it’s an important conversation for families to have, especially when it comes to advanced care planning. Everyone should understand their loved ones’ wishes for end-of-life care, including whether they’re comfortable with a do-not-resuscitate (DNR) — the legal order that states whether you want to be revived by CPR or life support if you stop breathing or your heart fails.
While the term DNR has been used in the medical community for decades, there’s still confusion about what it really means. Now, some hospitals are adopting a new term called “allow natural death” (AND) to provide clarity for patients and their families. Changing the terms may make it easier for families to discuss end-of-life care and make the best decision in accordance with their loved one’s wishes.
Why Request a DNR?
Research suggests the use of DNR orders has become increasingly common — but in the event that a patient hasn’t clearly communicated their wishes, that puts family members in the difficult position of having to make the decision on their loved one’s behalf.
People who are terminally ill or under hospice or palliative care may choose to implement a DNR because they’ve already come to terms with their prognosis. Maybe they are experiencing daily pain or don’t want to prolong the treatment process when their outcome is unlikely to change. Others may implement a DNR to ease the burden on their family in the event of a traumatic accident, so that their loved ones aren’t tasked with guessing their wishes.
Unfortunately, in some cases, there can still be confusion about what happens next.
A DNR doesn’t mean you’re asking for lower-quality or less aggressive care. After a doctor writes the order upon the patient’s request, the care team knows not to administer CPR if the individual’s heart stops or if they stop breathing. This doesn’t mean that hospital staff will no longer prioritize your care, nor does it mean they can’t use other medical interventions or give you medication for pain. A DNR order just makes it clear that you don’t want your health care provider to initiate CPR or to try to resuscitate you.
Is AND a Better Term?
While DNR orders have been used in hospitals for years, it’s understandable why some could feel negatively about the term. “Do not resuscitate” focuses on what the caregivers are not doing, while “allow natural death” implies the care team is doing everything it can to make the patient as comfortable as possible.
In this way, AND sounds more compassionate. Studies suggest using AND can change how patients and their families approach end-of-life care decisions, because DNR orders are often “ambiguous and require complex understanding between several parties.” The Hospice Patients Alliance has also said the term DNR often terrifies patients and their families and comes across as harsh and insensitive.
Those who support replacing the term DNR with AND say language really matters and suggest the change could increase the number of people with terminal illnesses who are allowed to die on their own terms. It may also help shift the emphasis away from withholding care to empowering patients to make their own care decisions.
Communication Is Key
As more hospitals use this new terminology, it’s crucial for families to have end-of-life care conversations. Whether it’s called a DNR or AND, you should know what your loved one would want if they suffer a traumatic, life-threatening injury or face a terminal illness. Many of these situations happen unexpectedly, but that doesn’t mean you can’t prepare for them.
Try to initiate the conversation after your loved one has a hospital visit, or tell them you’ve been thinking about the subject on your own and were curious about their perspective. If you don’t know where to begin, this starter kit from the Conversation Project, a partner of Honoring Choices Massachusetts, can help you navigate how to talk to your loved one.
In matters of life and death, making decisions about how to care for someone you love is even more difficult, but having a serious discussion about your loved one’s wishes well in advance can help you act in his or her best interest — and ensure that doctors, nurses and other medical staff do the same.