Guidelines for perioperative do-not-resuscitate policies

Waisel, David B; Burns, Jeffrey P; Johnson, Judith A; Hardart, George E; Truog, Robert D

« Previous Next »Journal of Clinical Anesthesia
Volume 14, Issue 6 , Pages 467-473, September 2002

Guidelines for perioperative do-not-resuscitate policies

Presented in part and as an abstract at the 12th World Congress of Anesthesiologists, Montreal, June 4–10, 2000.

David B Waisel, MD
- Department of Anesthesiology, Children’s Hospital, Boston, MA 02115, USA
- Address correspondence to Dr. Waisel at the Department of Anesthesiology, Bader 3, Children’s Hospital, 300 Longwood Ave., Boston, MA 02115, USA.
- Assistant Professor of Anaesthesia, Harvard Medical School; Associate in Anesthesia, Children’s Hospital
Jeffrey P Burns, MD
- Department of Anesthesiology, Children’s Hospital, Boston, MA 02115, USA
- Assistant Professor of Anaesthesia, Harvard Medical School; Associate in Anesthesia, Children’s Hospital
Judith A Johnson, BA, MA, JD
- Department of Anesthesiology, Children’s Hospital, Boston, MA 02115, USA
- Lecturer in Anesthesia, Harvard Medical School; Office of Ethics, Children’s Hospital
George E Hardart, MD
- Department of Anesthesiology, Children’s Hospital, Boston, MA 02115, USA
- Instructor in Anaesthesia, Harvard Medical school; Assistant in Anesthesia, Children’s Hospital
Robert D Truog, MD
- Department of Anesthesiology, Children’s Hospital, Boston, MA 02115, USA
- Professor of Anaesthesia and Medical Ethics, Harvard Medical School; Director, Medical Intensive Care Unit, Children’s Hospital

Received 8 November 2001; accepted 11 March 2002.

Abstract

This paper reviews some of the difficulties in implementing perioperative reevaluation of do-not-resuscitate (DNR) orders and suggests several strategies for perioperative DNR policies. Policies should be written, designed and implemented at the level of the institution, and be sufficiently flexible to permit the tailoring of the perioperative DNR order to the individual patient. Policies should unambiguously state that reevaluation is required, delineate responsibilities for reevaluating the DNR order, state all the available options, define the necessary documentation, and list resources for help.

Keywords: Anesthesia, cardiopulmonary resuscitation, ethics: do-not-resuscitate policy, hospital policy, surgery