Interpretation of Do Not Attempt Resuscitation Orders for Children Requiring Anesthesia and Surgery

Area of Science:

• Pediatric Anesthesiology
• Medical Ethics
• Informed Consent

Background:

• Pre-existing do not attempt resuscitation (DNAR) or limited resuscitation orders for children and adolescents present unique ethical and clinical challenges.
• Decisions regarding resuscitation involve complex considerations of patient rights, parental autonomy, and clinician roles.

Purpose of the Study:

• To outline key considerations for clinicians managing pediatric patients with DNAR or limited resuscitation orders undergoing anesthesia and surgery.
• To propose a framework for re-evaluating DNAR orders within the informed consent process for pediatric surgical procedures.

Main Methods:

• This clinical report synthesizes ethical principles and clinical best practices.
• It reviews the rights of children, parental decision-making, informed consent, and the roles of surgeons and anesthesiologists.
• It introduces the concept of "required reconsideration" for DNAR orders.

Main Results:

• The report highlights the importance of distinguishing between goal-directed and procedure-directed resuscitation limitations.
• It underscores the need for a collaborative approach involving parents/guardians and clinicians.

Conclusions:

• A structured "required reconsideration" process integrated into informed consent is crucial for pediatric surgical patients with DNAR orders.
• Tailoring resuscitation decisions—full, procedure-limited, or goal-limited—to the individual child's needs ensures optimal care.