Perioperative do-not-resuscitate orders--doing 'nothing' when 'something' can be done.

Area of Science:

• Medical Ethics
• Surgical Care
• Resuscitation Medicine

Background:

• Cardiopulmonary resuscitation (CPR) can prolong terminal illness and resource use.
• Do-not-resuscitate (DNR) orders were created to respect patient autonomy but face complexities.
• Historically, DNR orders were often suspended during the perioperative period.

Purpose of the Study:

• To review the origins and impact of DNR orders in the perioperative setting.
• To outline factors complicating the withholding of CPR for surgical patients.
• To offer practical suggestions for perioperative care providers regarding DNR orders.

Main Methods:

• Literature review on the history and practice of CPR and DNR orders.
• Analysis of ethical and legal precedents concerning resuscitation.
• Examination of challenges in implementing DNR orders in the operating room environment.

Main Results:

• CPR became a default intervention requiring explicit orders to withhold.
• The policy of 'required reconsideration' of DNR orders was proposed but faces practical hurdles.
• Obstacles to DNR observance in surgery include issues with the order itself and the OR environment.

Conclusions:

• Withholding CPR in the perioperative setting presents unique challenges.
• Practical strategies are needed to improve adherence to DNR orders for surgical patients.
• Further discussion and practical solutions are essential for respecting patient autonomy in perioperative care.