Article contents
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
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
- Information
- Copyright
- Copyright © Cambridge University Press 1995
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
- 2
- Cited by