Language Makes Difference to Cancer Patients

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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.


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.


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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