Allow natural death
Allow Natural Death (AND) is a medical term defining the use of life-extending measures such as cardiopulmonary resuscitation (CPR). These orders emphasize patient comfort and pain management instead of life extension. Currently, American medical communities utilize "do not resuscitate," (DNR) orders to define patients' medical wishes. Those who propose to replace DNR with AND posit that DNR orders are ambiguous and require complex understanding between several parties, while AND orders are clearer.
DNR VS AND
DNR orders range from solely prohibiting the use of resuscitation to prohibiting any action seen as life extending. Because there are many parties involved in a patient's end of life care - significant others, family, personal doctors, specialists and nurses - DNR orders are not always completely clear, leaving open possible violation of the patient's wishes. "DNR orders may lead to conflict, unnecessary suffering, and inappropriate care at the EOL [end of life.]" Those who propose to replace DNR orders with AND orders posit that AND are less ambiguous, clearly instructing medical personnel to not use any artificial, life extending measures. This would be especially helpful in regards to emergency care, when medical personnel who are unfamiliar with the patient must decide what medical practices should be used. Pros are that AND increases clarity on meaning and the choice of life or death. Also it doesn't use negative wording that could be confusing to interpret. Furthermore, proponents of AND claim that because it contains "death" in the title it is more clear to the patient and family exactly what the patient is agreeing to.
Critics of AND claim it is simply the replacement of one ambiguous term with another. Cons include that death can be vague and CPR isn't mentioned in the phrase. Just as DNR particulars vary so too would AND particulars vary. Thus, the change would be ineffective.
AND terminology represents an ideology of patient care that emphasizes bodily autonomy and respect of the individual. As opposed to "do not resuscitate", which has been criticized for placing emphasis on potential negative outcomes associated with hospitalization—the act of "not" resuscitating is a conscious decision to "not" engage in life-extending care. Proponents of AND argue that, by "allowing" natural death, the provider is, instead, consciously deciding to engage in care; although such care is not life-extending, this form of care respects the wishes of patients to die peacefully, in their minds.
AND and DNR share similar ethical dilemmas, however, in cases of attempted suicide or medical mismanagement, as such cases raise questions surrounding the meaning of a "natural" death. Some argue that, in special cases such as these, physicians should have the capability to revoke DNR or AND, though a wide consensus has yet to be reached.
Studies and Outcomes
Most studies regarding AND are surveys based on hypothetical situations and are given to specific groups. One study gave a scenario regarding loved ones to nurses, nursing students, and people with no nursing background. Each group rated how likely they were to agree to end of life care when DNR or AND was used. Participants were significantly more likely to agree to end of life care when AND was used.
Another study found similar results when giving a scenario to 524 adults- end of life care was more accepted when AND was used.
However, when patients with cancer were given a scenario about how much time they had left to live (1 year, 6 months, or 1 month), the results were different. In two studies conducted by the same authors, there was no significant difference in choosing end of life care when AND or DNR was used.
Finally, an anonymous survey asked residents and doctors about their experience with end of life care after their hospital switched to using AND over DNR. A majority agreed that using AND improved discussions about end of life care and decreased the burden of decision making.
There are barriers that exist in implementing "allow natural death". Some argue that costs will occur with the need to reeducate clinical staff and replace forms and edit electronic medical databases. People are looking into high-end care for when it comes to end of life decisions and AND can help provide more autonomy for patients.
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