Allow Natural Death (AND vs. DNR)

[mucifer]

As a hospice nurse I really like this concept and I hope it catches on. Here is an interesting article on it:


Allow Natural Death--An Alternative To DNR? by Reverend Chuck Meyer

Health care workers of all kinds--physicians, nurses, chaplains, social workers and case managers--inadvertently terrify patients and their families with medical terminology perceived as harsh, insensitive, and downright confusing. A prime example is the "Do Not Resuscitate" (DNR) order. Perhaps the time has come to replace the concept of DNR with a gentler, but in fact more definitive, approach--Allow Natural Death (AND).
Examining "Do Not Resuscitate" Orders

When we health care professionals speak to patients and family members about DNRs, all too often the family believes we will abandon care and stop all treatment. Yet, all the DNR is designed to do is relay the information that it is the patient/family wish that resuscitation attempts (CPR) will not be started if the patient dies. Regardless of how much time and energy we spend explaining DNR orders to the family, often all they hear is the "not" in "do not resuscitate." This negativism confuses many people, who think that approving a DNR order gives permission to terminate their loved one's life. Or, they may be reluctant to agree to the order because they feel guilty that they are not helping their loved one as they feel they should.

As most of us in the medical field know, asking for a DNR does not mean that we have stopped care. What it means is that we have simply changed the goal of treatment. But to patients and family members who are emotionally--not clinically--involved in the situation, this truth may not be apparent.

While a completed DNR tells physicians and other medical professionals not to start CPR if the patient suddenly goes into cardiac arrest, the order does not differentiate between a terminally ill patient and a potentially healthy person who may die due to current circumstances. A non-terminal patient may be in a DNR category and continue to receive aggressive or supportive treatment aimed at a cure or at nudging him through this medical crisis. If symptoms start to respond, then the DNR category might even be changed to a full code.

more at:http://www.hospicepatients.org/and.html

[NV Whino]

1. I like this idea

[pipoman]

2. Wording could make a difference in some cases

It is hard for me to put myself in a category of not understanding the spirit of a DNR as it relates to a hospice patient. I just went through this with my mother who died 2 weeks ago. She worked for an oncologist for years, my sister is an RN, and I worked in the legal industry for years, so we all knew what a DNR does and doesn't do. The only aspect, and frankly the most difficult part, of my mother's ultimate death, was at the very end when her lungs began filling up. She was gasping when I got there, I believe she was waiting for me to drive the 40 minutes to get there. Her fingers were turning blue. I wish someone would have given her O2, it was right there and don't believe it would have violated the DNR. When I told her we were all there she opened her eyes, looked into my eyes, took a breath, closed her mouth, the first tear I had seen from her flowed down her cheek, she closed her eyes and never took another breath. Overall, my heart is broken, I will miss her immensely, but it was about as good as it could be.

In the end, DNR or AND, same result. This process isn't easy for anyone involved.

[mucifer]

5. My fathter died at home with hospice and I am a hospice nurse

I can tell you oxygen suction IV morphine and comfort medications steroids and many more things are comfort care and are covered in hospice. Oxygen may or may not have helped your mother. Some cases in the final hours with medications to dry up secretions, suction, oxygen and morphine there still is the strong gasping for air at the end. Also, several hospice doctors have told me if the person pulls off the oxygen a fan can work just as well for comfort. Oxygen isn't a necessity. This happened with my dad. It's very hard as a family member to realize it is part of the process. My dad did have tears in his eyes the moments before he died and he was listening to my mother, my brothers and me tell him how much we love him. It was something we will never forget.

[etherealtruth]

3. As a former hospice nurse

I like this idea, as well.

The term "do not resuscitate" conjures up harsh and negative images in the minds of folk that are already distraught. Most people confronted with this can't even conceptualize that resuscitation will most likely not work and will actually lead to a "violent" death (for those suffering from a terminal illness).

[roguevalley]

8. my parents went this way and I was so glad. it was so peaceful and

'easy'. I have a DNR and my niece who we share a mutual adoration society (I was her first and fifth grade teacher as well) told me when I mentioned it to her: "Fuck that! We're resusitating!"

I still laugh. She will do the right thing but her expression was so cute.

[etherealtruth]

10. I am sorry for your losses

... but, I am glad that your parents went with peace.

[roguevalley]

11. thank you so much. they went ten months apart but peacefully

my dad waited until everyone was there and the last word my mother said was my name. that is what I remember, their calmness, their peacefulness. i wish it for everyone.

[Hoyt]

4. Good idea. I agree it is confusing for many. Personally, I support euthanasia.

[enough]

6. Having been through this with both my mother and my father in the past year,

I can say that the AND would have been a great help. It's very hard to talk with someone who is somewhat mentally impaired (but still somewhat competent) about NOT giving care or assistance or rescue to them in need. With the DNR, that is the way they hear it -- I am going to be left to die without any help. This would be frightening to anyone.

I dearly wish we had had the concept of AND at that time.

And a message of thanks and gratitude to all hospice workers who are reading this thread!

[riverwalker]

7. I find most people do not understand

what DNR means. I always put it in a way they can understand and am very honest. I ask if grandmas heart stops, should we let her slip away peacefully, or do you want us to pound on her chest, shock her with electricity and stick a tube down her throat and nose?
After witnessing futile Full Codes on terminal elderly people, you become convinced it is mothing short of torture.

[mucifer]

9. I tell people resusitation is not a cure for cancer.