Memo from the Editor

Time to abandon the DNR

I recently heard a commentator on National Public Radio suggest that we abandon the DNR designation. It's too negative. We're denying something-resuscitation-to the patient. We're asking patients and their families to give up something. We're asking nurses and doctors and paramedics to refrain from doing something that all their training compels them to do.

The commentator was not suggesting, however, that we abandon the principle that underlies the DNR. Merely that we change the language we use to describe what's supposed to happen. We'll preserve the right of the patient or his surrogates to refuse to be kept alive by external means, but we'll put a more-positive spin on it. We'll describe the intent better.

The designation suggested: AND, for Allow Natural Death.

I saw just how hard it is first-hand after I refused permission to have my mother intubated following a massive cerebral hemorrhage. During the three days before she died, there were countless moments when nurses and doctors wanted to intervene-to run more tests, to start antibiotics when she spiked a fever, to continue trying to do something. Those actions had two effects on me-they made me continuously question whether I'd made the right decision, and they made me angry. Angry at those healthcare providers who were trying to rob me of a peaceful leave-taking and my mother, who had metastatic colon cancer, of a peaceful death.

The Terri Schiavo case has brought medical intervention in the dying process to the fore again, joining her name forever with those of Karen Ann Quinlan and Nancy Cruzan, the other death-with-dignity causes célèbres. Their battles were at a different stage along the continuum than the DNR question raised here, but the fact that the nation is again talking about life and death issues makes it a good time to address it.

We choose to allow natural death every day; we just do it guiltily, reluctantly, as if we've failed at something, as if we've given up. How much better, for all involved, if we're simply able to acknowledge the completion of the cycle that is the miracle of life and death.

I ask all of you who believe there's merit in this change of terminology to propose it to the hospitals with which you're affiliated and to your state and specialty societies. AND is a conjunction, a joining, an indication that there's more to come. Let's carry that perspective to the process of dying and the words we use for it.