DNR- Do Not Resuscitate
DNAR- Do Not Attempt Resuscitation
AND- Allow Natural Death
Here are some acronyms that are important to write down, memorize and research.
The meanings can vary from person to person and the meaning of “avoid extraordinary means to prolong life” can waiver when the time comes for you, if you don’t have your wishes down.
Death can come quickly in a traumatic accident, acute medical condition (aneurysm or massive heart attack). An illness or condition that slowly takes over the body (MS or Alzheimer) or the one day that we take our last breath after decades of adventures(Natural Causes).
As a first responder for 20 years, I’ve seen every possible spectrum of death- and what I’ve decided is that because it sucks, we don’t talk about it, so we make it suck even more. Families don’t talk about it, so the medical professions at all levels (ER, general practitioners, nurses, surgeons, caregivers, palliative care and hospice first responders) have to open up the lines of communication and get people thinking of their final wishes early.
A DNR order is an old term, but is still used to make sure that all medical staff, usually in a hospital setting, on different shifts, just respect the decision of the patient or family authority to not call a “Code” response, if the patient went into cardiac arrest. Full attempt to resuscitate.
This order then traveled out into the field to first responders to respect “wishes” or “orders” for those patients who were sent home for their final days. Hence, the “Orange” form, which is a legal document from a licensed physician to be followed. If one does not have the “Orange” form
then a 911 response is a “Full Code.”
The DNR term has tried to change to DNAR- Do not ATTEMPT Resuscitation in an attempt to try and send the message to loved ones that having a DNR or DNAR was not an action of giving up or condemning a love one to death. This form does not suggest LESS care in the death transition. It is a way to say “Please” my frail body cannot likely survive a CPR assault! “STOP”
It truly is an assault–broken ribs, popped veins, tubes down throats and hearts shocked at tremendous joules to attempt a rhythm. Most of the time, the bodies are so weak, that it is so cruel to place medical personnel in that position. But we do it, because the laws are in place and a legal document is needed. It’s difficult on everyone. Only about 10%-15% of individuals survive and have a quality of life to leave the hospital, when CPR is attempted. This is when the death sentence has already happened.
Would the decision be any clearer, easier or less painful if the order was instead called AND – Allow Natural Death?
Keep in mind that patients views on the subject may be very different than the family members, decision makers and loved ones once the patient is unable to voice their wishes.
It has to be “what the patient would have wanted” and “what quality of life meant to them”.
Tough decisions can create a bitter emotional environment. Promoting consistent high quality end of life care, with dignity and love, to aid in the transition is a matter of putting it in writing.
Communication is the key!
Death, with dignity, surrounded by loved ones doesn’t make it easier, but a peaceful transition to “somewhere” is all we can hope for.