AND is a medical order that was first identified in the 1990s as being a better way to address planning for the end of a life. It has resulted in significant discussions within the medical community and has been implemented in many locations. One may ask, isn’t this really a DNR (Do not Resuscitate) order? Although the end result, of death, may be the same, the context in which that death occurs can be very different. A DNR order implies that the medical team will not be doing something and may be viewed as a failure of treatment by those concerned. AND, on the other hand, reflects a philosophy of providing comfort rather than cure and letting nature take its course. It emphasizes what will be done for the patient to help them through the end of their life and is proactive versus reactive in focus. This is not only important for the patient and their family but also for the healthcare workers as well. Research has found that nurses and physicians feel great distress when witnessing the suffering of dying patients, especially when treatment merely prolongs suffering. This suggests that the AND approach might also reduce clinicians’ distress.
In bringing this subject up, I am by no means saying that AND is a decision that you need to make now. And, that is the problem. Because it is not an imminent issue for us, we tend to put discussion of the subject totally off of our radar screen. What I want you to understand is that you do this at your peril. Understanding your end of life options now while you are healthy and not in need of them will build an understanding and resilience that will prove extremely useful when you, or someone you love, is faced with an end of life scenario.
But how might you do that when everything seems to be going along on an even keel and there is no crisis? This is truly the best time. Seek out advance care planning, palliative care, and end of life programs. They are taught through senior centers, health care organizations, faith groups, and Death Cafes. They are taught by Death Doulas, Registered Nurses, Social Workers, Physicians, and others. You will be surprised that they are going on all around you, you’ve just never noticed. Use the internet to search for them, sign up and attend. Knowing what your options may be in the future is helpful. It goes along with my emphasis on how important it is to:
Have ‘The Conversation’
And
Give ‘The Gift’
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