Allow-Natural-Death (AND) Orders: Legal, Ethical, and Practical Considerations
- First Online:
Conversations with patients and families about the allow-natural-death (AND) order, along with the standard do-not-resuscitate (DNR) order during end-of-life (EOL) decision-making, may create engagement and understanding while promoting care that can be defended using enduring notions of autonomy, beneficence, and professional duty. Ethical, legal, and pragmatic issues surrounding EOL care decision-making seem to suggest discussion of AND orders as one strategy clinicians could consider at the individual practice level and at institutional levels. A discussion of AND orders, along with traditional DNR orders is presented. This is followed by argument and counter-argument focused on ethical, legal, and practical issues germane to EOL care decision-making associated with use of AND orders.
KeywordsAllow-natural-death Do-not-resuscitate End-of-life care Advance directives
- American Health Decisions. (1997). Executive summary. The quest to die with dignity: An analysis of Americans’ values, opinions, and attitudes concerning end-of-life-care. A Report to the Robert Wood Johnson Foundation prepared for American Health Decisions. Retrieved from http://www.ahd.org/The_Quest_to_Die_With_Dignity.html.
- Asch, D., Hansen-Flaschen, J., & Lanken, P. (1999). Decisions to limit or continue life-sustaining treatment by U.S. critical care physicians: Conflicts between physicians’ practices and patients’ wishes. American Journal of Respiratory and Critical Care Medicine, 151(2), 288–292.CrossRefGoogle Scholar
- Asselin v. Shawnee Mission Medical Center, 894 F. Supp. 1479 (D. Kansas 1995).Google Scholar
- Baker, R. (1995). The 1988 DNR reforms: A comparative study of the impact of the New York DNR law and the JCAHO accreditation requirements. In R. Baker, M. A. Strosberg, & J. Bynum (Eds.), Legislating medical ethics: A study of the New York State do-not-resuscitate law (pp. 263–302). Boston, MA: Kluwer Academic.CrossRefGoogle Scholar
- Chessa, F. (2004). “Allow natural death” not so fast. Hastings Center Report, 34(5), 39.Google Scholar
- Cohen, R. W. (2004a). In response to “Allow natural death” not so fast. Hastings Center Report, 34(5), 39.Google Scholar
- Cohen, R. W. (2004b). A tale of two conversations. Hastings Center Report, 34, 49.Google Scholar
- Cruzan v. Director, Missouri Department of Health, 497 U.S. 261 (1990).Google Scholar
- Dumot, J. A., Burval, D. J., Sprung, J., Waters, J. H., Mraovic, B., Karafa, N. T., … Bourke, D. L. (2001). Outcome of adult cardiopulmonary resuscitation at a tertiary referral center including results of “limited” resuscitations. Archives of Internal Medicine, 161, 1751–1758.CrossRefGoogle Scholar
- Georgia Advance Directives for Healthcare Act 2007 O.C.G.A. § 31-32-1 (2007).Google Scholar
- Georgia Living Will Act 1984 O.C.G. A. § 31-32-1 (1984).Google Scholar
- Hastings Center. (2008). Bioethics briefing book. Retrieved from http://www.thehastingscenter.org/Publications/BriefingBook/Default.aspx.
- Jonsen, A. R., Siegler, M., & Winslade, W. J. (2010). Clinical ethics: A practical approach to ethical decisions in clinical medicine (7th ed.). New York: McGraw Hill.Google Scholar
- Kleinman, A., Eisenberg, L., & Good, B. (2006). Culture, illness, and care: Clinical lessons from anthropologic and cross-cultural research. The Journal of Lifelong Learning in Psychiatry, IV(I), 140–149.Google Scholar
- Koch, K. A. (2008). Allow natural death: “Do not resuscitate” orders. Northeast Florida Medicine Supplement, 59, 13–17.Google Scholar
- Kranson v. Valley Crest Nursing Home, 755 F.2d 46 (3d. Cir. 1985).Google Scholar
- Meisel, A., Snyder, L., Quill, T., & for the American College of Physicians and American Society of Internal Medicine End-of-Life Care Consensus Panel. (2000). Seven legal barriers to end-of-life care: Myths, realities, and grains of truth. Journal of the American Medical Association, 284(19), 2495–2501. Retrieved from http://jama.jamanetwork.com/article.aspx?volume=284&issue=19&page=2495.Google Scholar
- Meisel, A., & Cerminara, K. (2004). The right to die: The law of end of life decision making (3rd ed.). New York: Aspen Publishers.Google Scholar
- Meisel, A., & Cerminara, K. (2005 Supp.). The right to die: The law of end of life decision making (3rd ed.). New York: Aspen Publishers.Google Scholar
- Meyer, C. (2010). A new designation for allowing natural death (AND). Hospice Patients Alliance. Retrieved from http://www.hospicepatients.org/and.html.
- Nursing and Midwifery Council. (2004). The NMC code of professional conduct: Standards for conduct, performance, and ethics. London: Author.Google Scholar
- Patient Safety Authority. (2008). Understanding living wills and DNR orders. Pennsylvania Patient Safety Authority, 5(4), 111–117. Retrieved from http://patientsafetyauthority.org/ADVISORIES/AdvisoryLibrary/2008/Dec5(4)/Pages/111.aspx.
- Payne v. Marion General Hospital, 549 N.E.2d 1043 (1990).Google Scholar
- Patient Self-Determination Act of 1990, 42 U.S.C.A. §§ 1395cc, 1396a (1994).Google Scholar
- President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. (1982). Appendix II: Summaries of the reports. Washington, DC: U.S. Government Printing Office. Retrieved from http://bioethics.georgetown.edu/pcbe/reports/past_commissions.
- President’s Council on Bioethics. (2005). Taking care: Ethical caregiving in our aging society. Washington, DC: Author.Google Scholar
- Re Quinlan, 70 N.J. 10, 355 A.2d 647 (1976).Google Scholar
- Salladay, A. A. (2002). DNR alternative: Making plans to “allow natural death”. Nursing, 32(5), 24–25.Google Scholar
- Selinger, C. P. (2009). The right to consent: Is it absolute? British Journal of Medical Practitioners, 2(2), 50–54.Google Scholar
- Skol, D. K. (2009). The death of DNR. British Medical Journal, 338, b1723. Retrieved from http://www.bmj.com/content/338/bmj.b1723.extract.
- Thaler, R. H., & Sunstein, C. R. (2008). Nudge: Improving decisions about health, wealth, and happiness. New Haven, CT: Yale University Press.Google Scholar
- Wittmann-Price, R., & Celia, L. M. (2010). Exploring perceptions of “do not resuscitate” and “allowing natural death” among physicians and nurses. Holistic Nursing Practice, 24(6), 333–337.Google Scholar
- Zoloth, L., & Charon, R. (2002). Like an open book: Reliability, intersubjectivity, and textuality in bioethics. In R. Charon & M. Montello (Eds.), Stories matter: The role of narrative in medical ethics (pp. 21–36). New York, NY: Routledge.Google Scholar