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The Do Not Resuscitate (DNR) order in the perioperative setting: practical considerations
1Department of Anesthesiology, Division of Critical Care Medicine, Virginia Commonwealth University, Richmond, Virginia.
Current Opinion in Anaesthesiology
|February 25, 2021
Summary
Discussing Do Not Resuscitate (DNR) orders before surgery is crucial. Anesthesiologists must address DNR status to ensure ethical patient care and respect autonomy during perioperative decision-making.
Area of Science:
- Medical Ethics
- Anesthesiology
- Surgical Care
Background:
- Addressing Do Not Resuscitate (DNR) status is vital for perioperative shared decision-making.
- Anesthesia and surgery present ethical challenges regarding DNR orders.
Purpose of the Study:
- To evaluate all aspects of DNR orders in the perioperative setting.
- To guide clinicians in navigating DNR discussions with patients and designees.
Main Methods:
- Review of existing literature and professional society guidelines.
- Analysis of ethical tenets: nonmaleficence, beneficence, and patient autonomy.
Main Results:
- Approximately 15% of surgical patients have a DNR order.
- Major societies (ASA, ACS) do not support automatic DNR reversal.
- Data on increased perioperative mortality for DNR patients is inconclusive.
Conclusions:
- Addressing DNR status is essential in the perioperative period.
- Ethical principles guide discussions regarding resuscitation preferences.
- Respecting patient autonomy is paramount in perioperative care.
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