Should do-not-resuscitate orders be suspended for surgical cases?

Area of Science:

• Medical Ethics
• Anesthesiology
• Healthcare Policy

Background:

• Perioperative do-not-resuscitate (DNR) orders face significant management challenges.
• Inconsistent implementation and poor acceptance of ethical DNR policies are prevalent.

Purpose of the Study:

• To review difficulties in managing perioperative DNR orders.
• To offer strategies for empowering ethically appropriate DNR policies.

Main Methods:

• Review of ethical practice in anesthesiology concerning DNR orders.
• Analysis of barriers to DNR policy acceptance and implementation.
• Development of strategies for institutional policy empowerment.

Main Results:

• Barriers include physician-patient and inter-physician value differences, misunderstandings, and medicolegal concerns.
• Effective policies require institutional-level design, flexibility for patient autonomy, unambiguous reevaluation mandates, defined responsibilities, and clear documentation.
• Policies must outline options and available resources.

Conclusions:

• A well-written perioperative do-not-resuscitate policy is essential for overcoming obstacles.
• Such policies are vital for a well-functioning perioperative DNR system.