“Do Not Resuscitate” or “Allow Natural Death?”
As I draft my book, Tradeoffs, I’ll occasionally comment here on some of the articles I find related to subjects it will cover. One of the chapters will address end-of-life issues. When I found this NYT blog post on re-naming the Do Not Resuscitate order (DNR), it also hit another of my sweet spots — the effectiveness of using positive language to change perception of an issue.
Here’s what the post said about calling the DNR “Allow Natural Death” instead:
“It’s only beginning to come to people’s attention,” said Ruth Wittman-Price, nursing department chair at Francis Marion University, who assessed use of the new term in a recent study in the journal Holistic Nursing Practice. “But a lot of paradigm changes in society start with a language change.”
The phrase “do not resuscitate” signals an intent to withhold or refuse, she pointed out. “It says you’re not going to do something.” To “allow natural death,” on the other hand, connotes permission…
“It doesn’t sound so overwhelming or scary,” said Christian Sinclair, associate medical director at Kansas City Hospice and editor of the Pallimed blog, who sees the term catching on.
Natural foods, natural childbirth — we’re inclined to favor natural stuff these days.
Easier to understand and comply with
And there you have it. Use language that says what you WANT, not what you’re against. Use language that falls in line with social mores, “natural” being one of them.
The post went on to talk about how difficult it can be to determine whether medicines or other procedures keep the spirit of the DNR. It observes that Allowing Natural Death (AND) provides greater clarity. This means a patient with an AND order makes it easier for the medical staff and the family (or health care proxy) to make decisions according to their wishes.
Ah, the power of clear and positive language!
Call for stories
I’d like to hear from anyone who has experienced making an end-of-life decision for a human being. Specifically, I’d like to talk to you about how clear the decision was to authorize further treatment or to stop interventions. Please either leave your comments here or email me your phone number so we can talk at a mutually-convenient time.
I agree with the language (especially since I have a signed DNR)
The problem, is convincing the lawyers. :^)
It’s all about context and the frame; good ol’neurolinguistic programming at it’s best. We saw how effective it was when they took the hospice counseling and turned it into Death Panels. Forces for good or evil.
I have been interested in the use of the words “Allow Natural Death” since I first heard about it six years ago.
It should be noted that the current trend is for A.N.D. to be used interchangeably with Do Not Resuscitate. Historically though it was meant to be a different set of orders for care that would have addressed a patient or family’s desire to use or NOT use things like; IV hydration, intubation(breathing tube), tube feeding, antibiotics.
It was an effort to cease procedures that would prolong the death of a person who was terminally ill with no expectation of meaningful recovery.
Twenty years of work in environments that care for frail elders has caused me to believe that frail elders suffer needlessly at the end of life by these prolonging measures. They are robbed of dignity peace and comfort. It is a timely topic. I believe us baby boomers want to do all we can to avoid such an end and that will take some doing.
Thank you very much for weighing in from your vast experience.