Do-not-resuscitate orders in the operating room: required reconsideration

Advances in medical technology are giving health care providers the tools with which to keep patients alive for longer and longer periods of time. However, in our struggle to keep patients alive, we must not forget that the patient is the one who controls his or her own destiny. Advance directives and do-not-resuscitate orders are becoming more commonplace as patients strive to make their wishes known to all who care for them. The use of such orders in the operating room has historically been a hotbed of controversy because it appears contrary to the necessity of surgery in the first place. Surgeons, anesthetists, operating room nurses, and others all have concerns regarding this issue, and they will be discussed here. The answer to the dilemma lies in a policy of "required reconsideration" to examine all factors of the do-not-resuscitate order and its applicability to the situation at hand.