Peri-Operative Status of “Do Not Resuscitate” (DNR)* Orders and Other Directives that Limit Interventions

Abstract

Patients with pre-existing DNR orders or other advance directives regarding treatment limitations receive care from anesthesiologists during surgical and diagnostic procedures. Such directives may create professional and ethical challenges and cause additional responsibilities for the anesthesiologist. Advance directives arise in one of two ways. Some patients will have recorded their decisions about future therapy in a written instructional directive or they may have appointed a proxy or substitute decision-maker to speak on their behalf, should they lose decision-making capacity. Other patients may have agreed to a DNR order or a level-of-intervention document following discussion and conversation with the health care professionals providing their care. On these aspects, the anesthesiologist should be familiar with the policies and legal procedure applicable to the situation. Regardless of the origin of the directive, it serves as an extension of the patient’s autonomous decision making and is meant to provide the healthcare team with guidance that informs about resuscitative interventions. [2] The context of a proposed intervention adds important information to any pre-existing advance directive. Therefore, policies and practices that result in the automatic suspension or uncritical acceptance of DNR orders or other directives are inappropriate.