If you’ve ever been admitted to a hospital, you (hopefully) were asked questions about your “code status”. Though it was likely not put in those words, patients are routinely asked what they would want to have done if there were a “code” situation. The code status is essentially a standing order that instructs the medical team what to do in case a patients heart were to stop or breathing became distressed.
Recently my health care facility adopted a new approach to addressing code status. Instead of using the traditional DNR status, we are replacing that term with the term “Allow Natural Death” (AND). The push to change from Do Not Rescucitate (DNR) to Allow Natural Death (AND) began as a movement rooted in the 1990’s and attributed to Reverend Chuck Meyer who felt that the current Do Not Resuscitate (DNR) order was inadequate. He proposed that rather than using a negative phrase (DNR) that describes what will not be done, a positive phrase (AND) which describes what will be done, will be more likely to be accepted by families. He reasoned that families struggle with the decision to remove care, and worry that their loved one will be left to suffer if they changed the code status to DNR. He thought that the change to AND will both provide reassurance that their family member will be kept comfortable, and that the change to a kinder and more positive wording is more likely to be accepted by families who are struggling with a difficult decision. AND detractors argue that the change is little more than semantics. They say that there is nothing inherent in the AND term itself that implies that a patient will be kept comfortable on their way to death. Continue reading “Code Status and Living Wills. . . And Why They Might Not Matter.”
–Deep Ramachandran, M.D.