Ethical dilemmas and decisions concerning the do-not-resuscitate patient undergoing anesthesia

The growing geriatric population in this country makes it increasingly difficult to deal with the number of do-not-resuscitate (DNR) orders. In part, this is due to an increase in the number of elderly undergoing anesthesia and surgery. It can also be attributed to a rise in complex legal, ethical, and moral issues these orders pose for the healthcare professional caring for the DNR patients, including anesthetists. The term "DNR" is confusing to many, including healthcare professionals. As patients progress through the perioperative period, this confusion is compounded by the fact that administration of anesthesia encompasses interventions that include intubation, ventilation, and fluid replacement. These interventions may be regarded as resuscitative efforts outside the operating room. The anesthetist must identify and sort through a maze of conflicting courses of action, which must match the patient's desires and personal rights. The topic of DNR orders is addressed as well as some of the moral and ethical dilemmas they pose for the Certified Registered Nurse Anesthetist (CRNA). Some solutions are offered to help the nurse anesthetist make those decisions that are most "right" for the patient.