Allow natural death

DNR orders range in the extent of life-saving measures to be avoided, from solely prohibiting the use of resuscitation to prohibiting any action seen as life extending. Because there are many parties involved in a patient's end of life care - significant others, family, personal doctors, specialists and nurses - DNR orders are not always completely clear, leaving open possible violation of the patient's wishes. However, DNR remains the popularly understood and used term in the medical and layperson settings. AND is yet another phrase for similar orders, and implementing it involves a term change. Those who propose to replace DNR orders with AND orders posit that AND is less ambiguous, clearly instructing medical personnel to not use any artificial, life extending measures. This would be especially helpful in regards to emergency care, when medical personnel who are unfamiliar with the patient must decide what medical practices should be used. Pros are that AND increases clarity on meaning and the choice of life or death. AND orders also don't use negative wording that could be confusing to interpret. Furthermore, proponents of AND claim that because it contains "death" in the title it is more clear to the patient and family exactly what the patient is agreeing to. Critics of AND claim it is simply the replacement of one ambiguous term with another. Cons include that death can be vague and CPR isn't mentioned in the phrase. Just as DNR particulars vary, so too would AND particulars vary. Thus, they argue that change would be ineffective. == Ethics ==

AND terminology represents an ideology of patient care that emphasizes bodily autonomy and respect of the individual. AND and DNR share similar ethical considerations with regards to end-of-life care. These considerations can involve the four main principles of biomedical ethics, including autonomy, beneficence, nonmaleficence, and justice. Autonomy can be thought of as a patient's right to self-determination and the right to decide what kind of care they should receive, which can be achieved through ANDs or DNRs. The principles of beneficence and nonmaleficence require that the healthcare providers are aware of their patient's AND and DNR statuses, and of their roles in that patient's end-of-life care. Lastly, the principle of justice refers to the obligation for healthcare providers to advocate for fair and appropriate treatment of their patients at the end of their lives, which requires abiding by the conditions expressed through AND and DNR. == Studies and Outcomes ==

Most studies regarding AND are surveys based on hypothetical situations and are given to specific groups. One study gave a scenario regarding loved ones to nurses, nursing students, and people with no nursing background. However, when patients with cancer were given a scenario about how much time they had left to live (1 year, 6 months, or 1 month), the results were different. In two studies conducted by the same authors, there was no significant difference in choosing end of life care when AND or DNR was used. Finally, an anonymous survey asked residents and doctors about their experience with end of life care after their hospital switched to using AND over DNR. A majority agreed that using AND improved discussions about end of life care and decreased the burden of decision making. == Future Directions ==

There are barriers that exist in implementing "allow natural death". Some argue that costs will occur with the need to reeducate clinical staff and replace forms and edit electronic medical databases. People are looking into high-end care for when it comes to end of life decisions and AND can help provide more autonomy for patients. == See also ==