Hostname: page-component-586b7cd67f-dlnhk Total loading time: 0 Render date: 2024-11-28T05:18:00.440Z Has data issue: false hasContentIssue false
  • English
  • Français

The “do-not-resuscitate” order in palliative surgery: Ethical issues and a review on policy in Hong Kong

Published online by Cambridge University Press:  09 January 2015

Wing Lok Chan
Wing Lok Chan*
Affiliation:
Department of Clinical Oncology, Queen Mary Hospital, Hong Kong
*
Address correspondence and reprint requests to: Chan Wing Lok, Department of Clinical Oncology, 1/F Professorial Block, Queen Mary Hospital, Hong Kong. E-Mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

A do-not-resuscitate (DNR) order, or “advance directive,” is commonly seen in the cases of palliative patients who express a wish to withhold specific resuscitative therapies in the event of a cardiac arrest. With recent technological advances, there are increasing numbers of palliative patients who undergo surgical interventions to treat their symptoms and discomfort. The decision to suspend DNR orders for palliative surgery is always a matter for debate. The present article describes a case and the ethical issues involved and gives some practical suggestions for those facing similar problems. We also review the latest DNR policy in Hong Kong.

Keywords

Cardiopulmonary resuscitationPalliative careSurgeryAnesthesiologyDo not resuscitateEthics
Type
Essay/Personal Reflections
Information
Palliative & Supportive Care , Volume 13 , Issue 5 , October 2015 , pp. 1489 - 1493
Copyright
Copyright © Cambridge University Press 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Abramson, N.S., Safar, P., Detre, K.M., et al. (1985). Neurological recovery after cardiac arrest: Effect of duration of ischemia. Brain Resuscitation Clinical Trial I Study Group. Critical Care Medicine, 13(11), 930–931.CrossRefGoogle ScholarPubMed
American Association of Perioperative Nurses (2014). Perioperative care of patients with do-not-resuscitate or allow-natural-death orders. Denver: AORN Inc. Available from http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&ved=0CB4QFjAA&url=http%3A%2F%2Fwww.aorn.org%2FClinical_Practice%2FPosition_Statements%2FSupporting_documents%2FPosStat_DNR.aspx&ei=sJNuVLSFL-SHsQSu6YKICw&usg=AFQjCNFL2MiL3ATWQqKZrbDHPtzZdavGLQ&sig2=2jKjjAdrimMsdQXQbHSWkg&bvm=bv.80185997,d.cWc.Google Scholar
American College of Surgeons (1994). Statement on advance directives by patients: “Do not resuscitate” in the operating room. Bulletin of the American College of Surgeons, 94, 29.Google Scholar
American Society of Anesthesiologists (1993). Ethical guidelines for the anesthesia care of patients with do-not-resuscitate orders or other directives that limit treatment. Park Ridge, IL: House of Delegates, American Society of Anesthesiologists.Google Scholar
Brindley, P.G., Markland, D.M., Mayers, I., et al. (2002). Predictors of survival following in-hospital adult cardiopulmonary resuscitation. CMAJ, 167(4), 343–348.Google Scholar
Cohen, C.B. & Cohen, P.J. (1991). Do-not-resuscitate orders in the operating room. The New England Journal of Medicine, 325(26), 1879–1882.Google Scholar
Ewanchuk, M. & Brindley, P.G. (2006). Perioperative do-not-resuscitate orders: Doing “nothing” when “something” can be done. Critical Care, 10(4), 219.Google Scholar
HAHO (Hospital Authority Head Office) Operations Circular (2002). HA guidelines on life-sustaining treatment in the terminally ill. Hong Kong: Hospital Authority. Available from http://www.ha.org.hk/haho/ho/adm/124655e.pdf.Google Scholar
HAHO (Hospital Authority Head Office) Operations Circular No. 9 (2014). HA guidelines on do-not-attempt cardiopulmonary resuscitation (DNACRP). Hong Kong: Hospital Authority. Available from http://www.ha.org.hk/haho/ho/cc/CEC-GE-6_en.pdf.Google Scholar
Hospital Authority (2010). Policy on do-not-resuscitate order and advance care planning. Hong Kong: Hospital Authority.Google Scholar
Liu, R. (2008). “Do-not-resuscitate” policy practice review. Hong Kong: Hospital Authority. Available from http://www.ha.org.hk/haconvention/hac2008/proceedings/pdf/Free%20Paper/SPP1-5.pdf.Google Scholar
Masuda, Y., Fetters, M., Shimokata, H., et al. (2001). Outcomes of written living wills in Japan: A survey of the deceased ones' families. Bioethics Forum, 17(1), 41–52.Google Scholar
Medical Council of Hong Kong (2009). Code of professional conduct. Available from http://www.mchk.org.hk/code.htm.Google Scholar
Panetta, L. (1990). Omnibus budget reconciliation act of 1990. Washington, DC: Government Printing Office. Available from http://faculty.ksu.edu.sa/hisham/Documents/Pharmacy_Docs/omnibus.pdf.Google Scholar
Santonocito, C., Ristagno, G., Gullo, A., et al. (2013). Do-not-resuscitate order: A view throughout the world. Journal of Critical Care. 28(1), 14–21. doi: 10.1016/j.jcrc.2012.07.005. Epub September 13, 2012.Google Scholar
Scott, T.H. & Gavrin, J.R. (2012). Palliative surgery in the do-not-resuscitate patient: Ethics and practical suggestions for management. Anesthesiology Clinics. 30(1), 1–12.Google Scholar
Sprung, J., Warner, M.E., Contreras, M.G., et al. (2003). Predictors of survival following cardiac arrest in patients undergoing non-cardiac surgery: A study of 518,294 patients at a tertiary referral center. Anesthesiology, 99(2), 259–269.Google Scholar
Waisel, D.B., Burns, J.P., Johnson, J.A., et al. (2002). Guidelines for perioperative do-not-resuscitate policies. Journal of Clinical Anesthesia, 14(5), 467–473.CrossRefGoogle ScholarPubMed
Walker, R.M. (1991). DNR in the OR: Resuscitation as an operative risk. The Journal of the American Medical Association, 266(17), 2407–2412.Google Scholar