A.N.D. – Allow Natural Death

medical decisions

Death by Natural Causes also called A.N.D. : Allow Natural Death.

Opting to have a ‘natural death’ means instead of life-prolonging interventions or organs being kept alive via life support, you’d prefer not to work against nature taking its course in life’s progression toward its end.

While ‘natural’ always seems to sound better, deciding you’d like to Allow Natural Death (A.N.D) can turn out to be more complicated than it expected because ‘natural’ does not equal ‘without suffering’

“Death in nature is often violent, brutal, and messy.Dr Alex Smith, Geriatrician and Palliative Care Docto

Examples of Natural Deaths

84-year old Ruth had been hospitalized since suffering a fractured neck and ribs in a car crash. After a sudden large stroke, the family chose to make her comfortable [rather than agree to a feeding tube] and she died several hours later. “My mother died to the sound of music: she died as we sang sons that accompanied our family road trips and camping adventures more than 40 years before We had no trouble remembering the words.”

From Dr Sherwin Nuland, late author of How we Die: Reflections on Life’s Final Chapter:

“One of Mickey’s happiest memories from right before Richard’s death is having the opportunity to feed him ice cream, a pleasure Richard had denied himself for years. “He was obsessive about his diet. The last week I fed Richard hot dogs and we talked about being kids going to baseball games and I gave him the richest ice cream and he loved it.” Sharing Richard’s death, says Mickey, “was a great gift.”

Mickey says these three experiences have forced him to consider how he would deal with a terminal disease. “I am determined not to spend my time looking for a cure . . . I watched my friends get caught up in fighting their disease. I want to spend the last days of my life doing what makes me happy.”

Examples of Not so Natural deaths

My mother had a horrible death. My mother died after 15 miserable days in an ICU. My mother died with a “crown of thorns” halo, screws bored into her skull, attached to a stiff chest harness that made it yet more difficult for her to breathe.She died having endured severe pain from broken ribs, her pain medicine restricted out of concerns for delirium. My mother died having suffered what she described as a ‘cold wind’ every time a CPAP (oxygen) mask was strapped to her face. Her mouth dried out, her lips cracked and she felt terribly thirsty. However, because of concerns about swallowing, she was only allowed ice chips” Dr. Paul B Bascom

“He has several chronic conditions — heart failure, weak kidneys, anemia, Parkinson’s and mild dementia — all tentatively held in check by a fistful of medications. He has been falling more frequently, and his appetite has fallen off, too. Now a stroke threatens to topple this house of cards. The ER physician and I talk briefly about what can be done. The stroke has driven the patient’s blood pressure through the roof, aggravating his heart failure, which in turn is threatening his fragile kidneys. The stroke is bad enough that, given his disabilities related to his Parkinson’s, he will probably never walk again. In elderly patients with a web of medical conditions, the potential complications of any therapy are often large and the benefits small. The family may ask me to use my physician superpowers to push the patient’s tired body further down the road, with little thought as to whether the additional suffering to get there will be worth it”. Internist, Dr Craig Bowron 

When thinking about A Natural Death there are different ways to think about and describe your idea of and priorities for ‘quality of life’ for example:

  • Able to enjoy _____
  • Able to participate
  • Able to feel productive
  • Able to give and receive affection

Depending on what worries you about A Natural Death, questions to consider:

  • Do I know and understand the probable course and outcome of my condition
  • What are my fears about what’s to come
  • What would I like to do – what are my goals – as time runs short
  • What trade-offs am I willing to make – how much suffering am I willing to go through – for the possibility of added time

This Decsion Aid, used by doctors to determe the best course of treatment, can help in thinking through your own best course of treatment

Important to remember: when completing your Advance Directives, using a planning tool such as BestEndings, as long as you’re ‘able’ you can change your end of life wishes.



Interesting Reading: Palliative and Hospice Care

Antibiotics and the Elderly

Dr Rebecca Sudore writes about her grandfather’s last days