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Allowing Natural Death [AND]

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An Emerging New Order for Financial Planners to Understand


The emerging new medical order to Allow Natural Death [AND] is meant to ensure that only comfort measures are provided to elderly or affected medical patients. By using the AND designation in advanced directives and living wills, physicians and FAs acknowledge that one is dying and that everything is being done–including the withdrawal of nutrition and hydration–to allow the dying process to occur as comfortably as possible.

Understanding Do Not Resuscitate Orders

While a DNR patient in an intensive care unit might be put on a ventilator, given artificial hydration, or have a feeding tube inserted; an Allow Natural Death patient would have all of those things withdrawn, discontinued, or not even started, since such treatments are painful and burdensome for the terminally ill. The AND would prevent this unintentional pain, and simply Allow a Natural Death.

Growing Impact

So far, this new AND concept has been presented to only several hundred hospitals throughout the United States as well as many hospices and nursing homes. Many are considering adding AND to their language, in order to reflect better the needs of their terminally ill patients.

The Hospice Patients Alliance group supports the creation of this new end of life care designation (A.N.D.) which is designed to increase the number of terminally ill patients who are allowed a death with dignity.

For example, AND is currently being used at the Round Rock Medical Center within the St. David’s Medical Center health system.

For more information on A.N.D., please contact Chaplain Amy Donohue-Adams by phone at 512-341-6493, and by e-mail at: amy.donohueadams@stdavids.com
Source: http://www.hospicepatients.org


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11 Responses

  1. The bean-counters are at it again. Of course, the cheapest medical care is no care at all. Since we will all eventually die, in a sense we are all terminally ill. It’s just a matter of when. Why not allow “natural death” to all instead of just the so-called “terminally ill”, a speculative term at best, with a definition subject to change according to mood and economic conditions.

    This over-simplified, misguided book is primarily concerned with the bottom line, and no amount of euphemistic buzz words and phrases can whitewash that. I can hear it now, “Oh, but we want to avoid ‘unintentional pain’ and ‘painful treatments’.” Anyone who has had a surgery, traumatic injury or any of various other maladies has experienced “unintentional pain” and “painful treatments”. Think of the money that would be saved if we would avoid expensive medical care in such cases and simply made people comfortable, letting nature take its course.

    No thank you. We don’t need non-physician, bean-counters with deceptive and misleading “Dr.” titles in front of their names making medical decisions. One has only to look at the state of the economy to judge the level of competance money mangers or, more accurately, mismanagers have demonstrated in their supposed area of expertise.



  2. Dear elToroso,
    Your rantings are sophomoric … now, please do tell us your solutions.
    Thank you.
    Nurse Jane


  3. Lovely … avoid commenting on the book and/or issues, rather attempt to insult the writer with a couple of lame cliches: “rantings” and “sophomoric”. Please.


  4. The book is a best-seller; but we all are still awaiting for your solutions. Read it!


  5. So then, you have no comments about the book, other than it is a bestseller, and no comment whatsoever about the issues. Instead you ask for my solutions in a feeble attempt to avoid the topic at hand. Hmmmm.

    Please remember, the topic under discussion is the book and the validity of the solutions it proposes concerning so-called “natural death”. My opinion concerning both has been expressed previously. The topic is not “what is my solution”, rather “are the solutions offered in the book valid and ethical”. As previously outlined, I believe they are not.

    Your only defense of the book is the claim that it is a bestseller. Bestseller? Really? Can’t seem to find it on any of the usual bestseller lists (NY Times, Chicago Trib, LA Times, Indy, Amazon etc.) I must be overlooking something. Where is it rated as a bestseller?

    Also, I’m curious what justifies the author’s “Dr.” title. It certainly isn’t the unusual listing of an MBA degree or the certifications listed after his name. Perhaps there is another degree which entitles him to that appellation?


  6. Hi eltorosa,

    A casual review of this blog, as well as the book itself, reveals that Dr. Marcinko was a board certified surgeon and certified financial planner, for almost two decades; with MBA and other credentials. As a registered investment advisor, and fiduciary healthcare consultant, he took a PPMC to Wall Street in the late 1990s. Moreover, he was a member of AHIMA, HIMSS, MS-HUG and SUNSHINE, when the second edition of the Business of Medical Practice, with Foreword by his colleague Ahmad Hashem; MD PhD [Global Productivity Manager for the Microsoft Healthcare Solutions Group] was produced. It rose to the rank of about 15,000 on the global Amazon best seller list, with industry sector rating of #7. We have just commenced work on the third edition.

    And, you will be delighted to lean that the chapter for this new edition: ETHICS AND MORAL PRINCIPLES IN MODERN MEDICINE, will be updated by Render S. Davis; MHA, CHE.

    Those of us in the rigorous ethics and healthcare philosophy policy space know Ren as certified healthcare executive. He served as Assistant Administrator for General Services, Policy Development, and Regulatory Affairs at Crawford Long Hospital of Emory University from 1977-95. Previously, he was an Administrator for Special Projects and Co-Chair of the Ethics Committee of Crawford Long Hospital, and an independent healthcare consultant in the areas of policy and ethics. He is currently employed in the Emory Healthcare Office of Quality and is involved with policy development, Joint Commission Accreditation preparation and training, and ethics. He is a founding board member of the Health Care Ethics Consortium of Georgia and has served on the consortium’s Executive Committee, Advisory Board, Futility Task Force, Strategic Planning Committee, and has chaired the Annual Conference Planning Committee since 1995. He was the 2008 recipient of the Health Care Ethics Consortium’s Heroes in Healthcare Ethics Award.

    Trust this info is helpful to you. Feel free to post your own credentials – or even your name – since you seem to contentiously labor in obscurity, with little conscientious industry exerted on your part. Submit your CV, with subject matter expertise verification, for book authorship consideration as well.

    Thank You
    Ann Miller, RN, MHA
    [Executive Director]



  7. Ann,

    Nice job on verbally removing eltorso’s cajones. He sure is missing something; important! Please ban him from the blog if he continues to embarrass himself.



  8. “Concurrent Care” and Medicaid

    The new Patient Protection and Affordable Care Act instructs Medicaid, the state-federal program for the poor, to cover simultaneous hospice and curative care for children with terminal illnesses immediately.

    And, it directs the federal Medicare program, which covers seniors and disabled people, to launch up to 15 pilot projects around the country to test the concept. If the experiment is deemed successful and doesn’t increase costs, then Medicare could make the benefit available to everyone in hospice.

    Dr. Davd E. Marcinko; MBA


  9. Patient Advocacy

    Few areas of life are as personal as an individual’s health and people have long relied on a caring and competent physician to be their champion in securing the medical resources needed to retain or restore health and function. And, for many physicians, the care of patients was the foundation of their professional calling.

    However, in the contemporary delivery organization, there may be little opportunity for generalist physician “gatekeepers”, resident, interns fellows, or “specialty hospitalists or intensivists” to form a lasting relationship with patients. These institution-based physicians may be called upon to deliver treatments determined by programmatic protocols or algorithm-based practice guidelines that leave little discretion for their professional judgment.

    In addition, the physician’s personal values may be impeded by seemingly perverse financial incentives that may directly conflict with their advocacy role, especially if a patient may be in need of expensive services that may not be covered in their insurance plan, or are beyond the resources of a patient’s HSA or savings.

    Hence AND and DNR orders, medical technology and related confusion puts modern doctors in a terrific ethical quandary.

    Dr. David Edward Marcinko MBA


  10. Changing Attitudes toward Assisted Suicide and a Patient’s Right to Die

    Beliefs regarding patients’ right to die and assisted suicide for terminally ill patients are changing, and the results of a recent survey reflect the cultural shift.

    According to the survey, not only are the majority of American adults (70%) supportive of the idea that terminally ill patients should have the right to choose to end their lives, two-thirds of all adults think that doctors should be allowed to advise terminally ill patients on alternatives to medical treatment and/or ways to end their lives.

    The survey finds that support for these measures is especially strong in the cases of terminally-ill patients who regularly experience great pain. Likewise, it is becoming more common for adult patients to have written directives or documented instructions about their own desires for end-of-life care.

    Physicians’ attitudes may be changing as well. A poll of 10,000 physicians in August-September 2010 revealed that 45% believe there are situations in which physician-assisted suicide should be allowed, while 40% do not.

    We want to know what you think!

    1. What role should doctor’s play when it comes to patients’ right to die and/or assisted suicide? Does your opinion on this matter change in cases involving terminally-ill patients?

    2. What are the key concerns and consequences of allowing physicians to discuss assisted suicide or other options with their terminally ill patients?

    3. Have you noticed an increase in the number of patients with written directives or documented instructions for end-of-life care?

    Link: http://www.hcplive.com/articles/Assisted-Suicide-For-Terminally-Ill-in-Pain-Deemed-Okay/?utm_source=Listrak&utm_medium=Email&utm_term=http%3a%2f%2fwww.hcplive.com%2farticles%2fAssisted-Suicide-For-Terminally-Ill-in-Pain-Deemed-Okay%2f&utm_campaign=Survey+Reflects+Changing+Attitudes+Toward+Assisted+Suicide

    Source: HCPLive


  11. Death and (estate) taxes … sometimes go together

    Because the “fiscal cliff” will not stop for death, it looks as if death’s carriage may make a “kindly” stop to pick up some American millionaires this year, to paraphrase Emily Dickinson.


    Dr. Death


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