•  Culture, Morals

Allow natural death.

I spend a fair amount of time reading other writers’ blogs—something that’s always entertaining, sometimes voyeuristic, and occasionally deeply thought-provoking. In the latter vein, I was delighted to learn last week, courtesy of Joanna Goddard, that some very smart people across the country are trying to change how we perceive and react to end of life issues by getting rid of ‘DNR.’

‘DNR’ stands for ‘do not resuscitate.’ For people who have signed a ‘DNR’ order as part of a hospital admission, or who have written it into their advance health directives, it means that they will not be brought back to life if they die. It does not mean that no heroic measures will be taken to keep them alive (that’s a separate set of requests—and, if you don’t enjoy the idea of breathing via a ventilator, a good reason to get going with an advance directive if you don’t already have one). Although the spouse and I have advance directives on file with our doctors, our attorney, our fiscal agent, and our health care agent, and although I am an enthusiastic advocate of pretty much every kind of choice being available to those who don’t have long to live, I have never been a fan of the ‘DNR’ acronym, much less the phrase it denotes. ‘Do not resuscitate’ sounds, to me, ominously close to something you might hear on ER (‘BP’s going nowhere, still 50 over 30.’ ‘Pulse ox 90.’ ‘Well, let’s hope there’s a do not resuscitate.’) or in 2001: A Space Odyssey (‘Open the pod bay door, Hal!’ ‘Sorry, David; I’m putting in a do not resuscitate order for you.’). It’s medical-ese masquerading as caring. Clunky, inelegant, overly clinical, and harsh, it simply doesn’t convey the image you want when you’re a doctor or family member dealing with what is, for many, a difficult and painful transition.

So what’s replacing ‘do not resuscitate?’ ‘Allow natural death,’ a phrase suggested and championed by the late Reverend Chuck Meyer, a hospital chaplain who, if you read between the lines, apparently got tired of having to explain what exactly ‘DNR’ meant to already-grieving families and suggested that something more compassionate replace the tired old acronym. As Meyer wrote, by using the more accurate phrase, ‘physicians and other medical professionals would be acknowledging that the person is dying….’ Not always the easiest thing to do if you’re a doctor and used to playing God, but a good idea, especially when it’s the truth. (Come on, guys—you can’t save everyone.) I don’t know about you, but I like the idea of a doctor admitting that a person will be leaving this earth soon, and of being given a chance, a real chance, to say goodbye when someone I love is dying. I also welcome the concept of allowing someone to complete a natural process—in a sense, empowering the dying person in his final days. And finally, I have always been uncomfortable with the implication that ‘do not resuscitate’ gives of somehow withholding some essential treatment from a dying person (that’s just not true, but doesn’t it sound like it could be?).

Allowing a natural death, as well as giving voice to what I am sure most people dying would want, invites a patient’s family into the process of death, which—as well as painful—can be funny, tender, graceful, enlightening, and beautiful. AND treats the patient and his family as partners in a process, rather than emphasizing the gulf between them and those with medical training. Finally, it achieves the commendable and recently honored goal of enabling a terminal patient to die with at least some dignity rather than with a crash cart standing at the ready, paddles poised for action. I don’t know about you, but the older I get, the more grateful I am for this particular trend.

The idea of ‘allowing natural death’ has been gaining adherents across the US for the last few years, starting with hospital chaplains and hospice nurses, who ought to know something about how to die. And the benefits of using the more compassionate terminology don’t just accrue to the patient—according to Rev. Cynthia Brasher, who led the AND effort at Lee Memorial Health System in Fort Myers, Florida, ‘More often than not, the body language of the family will soften’ when the phrase is used. For all the reasons we’ve already talked about, I’m not at all surprised by Brasher’s assertion. And I’ll be arranging to have ‘allow natural death’ written into my advance medical directive soon—because, if I ever need the services of my health care agent, I’ll want to know that she feels as good as she can about the job she’ll have to do to help me die. In the end, allowing a natural death is surely a gift we should all be prepared to give each other.