Finding the Words: Semantics Makes a Difference in End-of-Life Decisions

A rose by any other name may smell as sweet, but a simple choice of words can have a measurable impact on how people think about death.

Such is the finding of a study published in the January 2008 issue of Journal of Medical Ethics. Researchers measured how often study participants (nurses, student nurses and people with no health care backgrounds) would support a decision to allow death to progress when they were approached with the phrase “do not resuscitate” versus “allow natural death.” Nurses were likely to support the dying process regardless of what it was called, but all three groups were more likely to decline resuscitation if the words “allow natural death” were used.

To some intensive care doctors, the distinction between these three-word phrases is significant. “Do not resuscitate” carries a specific command to the attending medical team to forgo cardiopulmonary resuscitation, but allows life-saving measures up to that point. “Allow natural death,” on the other hand, suggests that doctors will limit interventions to providing comfort measures, rather than pursue more aggressive treatments that may only prolong the inevitable.

Many spiritual leaders and medical staff report that when they pose the question,  “Do you want to sign a ‘Do Not Resuscitate’ form?” families often balk because they think they are sentencing their loved one to death. But when the question is asked a different way – “Do you want to allow natural death?” – family members respond more openly as the burden of the decision is shifted in another direction.

Other professionals make the case that limiting a patient to the options implied by these two phrases oversimplifies a complicated choice. They say family members should instead be given a clear explanation of all the options and levels of care available to their loved one.

There is one thing on which most professionals can agree, however: end-of-life decisions become more crucial each advance in life-prolonging technologies and the growing list of ethical dilemmas involved in prolonging a life that can only be sustained by artificial means.