Language Makes Difference to Cancer Patients

Commentator Debra Jarvis is a chaplain for the Seattle Cancer Care Alliance. Recently, she met a dying patient who did not want to sign a Do Not Resuscitate (DNR) order, because it seemed like giving up. She told him that some hospitals call them ANDs - Allow Natural Death - and he was more comfortable with that language.

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MELISSA BLOCK, host:

When diet and drugs and other medical treatments are not enough for some cancer patients, they come to commentator Debra Jarvis. She's a chaplain at the Seattle Cancer Care Alliance. Many of the dying patients she works with sign DNRs, do-not-resuscitate orders. They don't want heroic measures taken to save their lives. But not all of them want to sign DNRs. Jarvis recalls one patient in particular.

DEBRA JARVIS:

Brian(ph) had advanced liver cancer. His one treatment of chemotherapy nearly killed him. He wanted to die at home, and he was already in a hospice program, but he refused to sign his DNR papers. Several people had tried to get him to sign his DNR: his doctor, his partner, his hospice nurse. His doctor asked me to give it a try. So I told Brian what would happen if he didn't have one: the pounding on the chest, the electrical paddles, the intubation, the trip to the ICU. `If you want to avoid this,' I said, `you have to sign the DNR papers.' `But DNR is choosing to die,' he said. `I can't just quit.' He was an athlete. The idea of giving up was foreign to him.

I had run into this before. With the phrase `do not resuscitate,' all patients hear is the `not.' So they feel as if the medical staff is going to abandon them completely or stand there and watch them die, flopping around like a fish out of water. As Brian and I sat there looking at each other, I recalled that there are hospitals where they do not call it DNR, but use the term AND, `Allow Natural Death,' instead of `do not resuscitate.'

`Brian,' I said softly, `you can choose to be AND, Allow Natural Death. It's just another name for DNR, so they'll allow you to die comfortably and naturally.' He repeated, `Allow Natural Death. Die naturally and comfortably. Well, that's just what I want.' `OK,' I said. `So we can tell your doctor to make you AND?' `Yes,' he said. So all his care providers knew what to do, allow him to die naturally, and two weeks later he did at home with his family and friends.

BLOCK: Reverend Debra Jarvis lives in Seattle.

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