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Ethics Committees at Work: Do Not Resuscitate Orders in the Operating Room: The Birth of a Policy

Published online by Cambridge University Press:  29 July 2009

Guy Micco
Affiliation:
Chair of the Ethics Committee at Alta Bates Hospital, Berkeley, California and an associate clinical professor in the Health and Medical Sciences Program, University of California, Berkeley
Neal H. Cohen
Affiliation:
Professor of Anesthesia and Medicine, Vice Chairman, Department of Anesthesia, and Director of Critical Care Medicine, University of California, San Francisco

Extract

The question of whether Do Not Resuscitate (DNR) orders should be sustained in the operating room was brought to our ethics committee by a pulmonologist and involved one of his patients for whom he serves as a primary care physician. His patient, a woman with chronic obstructive lung disease (COPD) was electing, for comfort purposes, to have a hip pinning following a fracture. At the same time, she wished to have a DNR order covering her entire hospital stay. The anesthesiologist described her direction as “improper” and refused to participate in surgical procedures if DNR orders extended to the operating room. The patient refused to rescind the order during surgery. As a result, the surgery was canceled to the great chagrin of the patient.

Type
Ethics Committees at Work
Copyright
Copyright © Cambridge University Press 1995

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References

1. Walker, RM. DNR in the OR: resuscitation as an operative risk. Journal of the American Medical Association 1991;266:2407–12.CrossRefGoogle ScholarPubMed

2. Youngner, SJ, Cascorbi, HF, Shuck, JM et al. , DNR in the operating room: not really a paradox. Journal of the American Medical Association 1991;266:2433–4.CrossRefGoogle ScholarPubMed

3. Cohen, CB, Cohen, PJ. Do-not resuscitate orders in the operating room. New England Journal of Medicine 1991;325:1879–82.CrossRefGoogle Scholar

4. Patterson, P. Suspension of DNR orders in the OR being questioned, OR Manager 1992:2.Google Scholar

5. West van Hall, SF, Nejdl, RJ, Landis, K. Understanding no CPR orders in the operating and recovery rooms. LACMA Physician 1992; 1:23. (includes guidelines developed by the LA County Medical Association (LACMA)/LA County Bar Association Joint Committee on Biomedical Ethics approved by both Associations in October of 1991).Google Scholar

1. Tomlinson, T, Brody, H. Ethics and communication in do-not-resuscitate orders. New England Journal of Medicine 1988;318:43–6.CrossRefGoogle ScholarPubMed

2. Truog, RD, Brett, AS, Frader, J. The problem with futility. New England Journal of Medicine 1992;326:1560–4.CrossRefGoogle ScholarPubMed

3. Council on Ethical and Judicial Affairs, American Medical Association. Guidelines for the appropriate use of do-not-resuscitate orders. Journal of the American Medical Association 1991:265:1868–71.CrossRefGoogle Scholar

4. Lo, B. Unanswered questions about DNR orders. Journal of the American Medical Association 1991;265:1874–5.CrossRefGoogle ScholarPubMed

5. Truog, T. “Do-not-resuscitate” orders during anesthesia and surgery. Anesthesiology 1991; 74:606–8.CrossRefGoogle ScholarPubMed

6. Walker, RM. Resuscitation as an operative risk. Journal of the American Medical Association 1991;266:2407–12.CrossRefGoogle ScholarPubMed

7. Youngner, SJ, Cascorbi, HF, Shuck, JM. DNR in the operating room. Not really a paradox. Journal of the American Medical Association 1991; 266:2433–4.CrossRefGoogle Scholar

8. Keffer, MJ, Keffer, HL. Do-not-resuscitate in the operating room: moral obligations of anesthesiologists. Anesthesia and Analgesia 1992;74: 901–5.CrossRefGoogle ScholarPubMed

9. Steer, PL. Do not resuscitate orders: considerations for the anesthesiologist. Anesthesiology Review 1992; XIX: 12–6.Google Scholar

10. Martin, RL, Soifer, BE, Stevens, WC. Ethical issues in anesthesia: management of the do-not-resuscitate patient. Anesthesia and Analgesia 1991;73:221–5.CrossRefGoogle ScholarPubMed

11. Fine, PG. Anesthesiology and the discipline of medical ethics: challenges and opportunities. Anesthesia and Analgesia 1992;74:327–8.CrossRefGoogle ScholarPubMed

12. Barash, P. Anesthesiology. Journal of the American Medical Association 1992;268:335–7.CrossRefGoogle ScholarPubMed

13. Cohen, CB, Cohen, PJ. Do-not resuscitate orders in the operating room. New England Journal of Medicine 1991;325:1879–82.CrossRefGoogle Scholar

14. Smedira, NG, Evans, BH, Grais, LS et al. , With-holding and withdrawal of life support from the critically ill. New England Journal of Medicine 1990;322:309–15.CrossRefGoogle Scholar

15. Webster, GC, Mazer, CD, Potvin, CA, Fisher, A, Byrick, RJ. Evaluation of a “do not resuscitate” policy in intensive care. Canadian Journal of Anaesthesiology 1991;38:553–60.CrossRefGoogle ScholarPubMed

16. Wilson, WC, Smedira, NG, Fink, C, McDowell, JA, Luce, JM. Ordering and administration of sedative and analgesics during the withhold and withdrawal of support from critically ill patients. Journal of the American Medical Association 1992;267:947–55.Google Scholar

17. Sulmasy, DP, Geller, G, Faden, R, Levine, DM. The quality of mercy. Caring for patients with “do not resuscitate” orders. Journal of the American Medical Association 1992;267:682–6.CrossRefGoogle ScholarPubMed

18. Wachter, RM, Luce, JM, Hearst, N, Lo, B. Decisions about resuscitation: inequities among patients with different diseases but similar prognoses. Annals of Internal Medicine 1989; 111:525–32.CrossRefGoogle ScholarPubMed