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

      Affiliations

    • Department of Anesthesiology, Children’s Hospital, Boston, MA 02115, USA
    • Corresponding Author InformationAddress 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

      Affiliations

    • 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

      Affiliations

    • 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

      Affiliations

    • 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

      Affiliations

    • 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.

References 

  1. Statement of the American College of Surgeons on Advance Directives by Patients. “Do not resuscitate” in the operating room. Bull Am Coll Surg. 1994;799:29
  2. Truog RD. “Do-not-resuscitate” orders during anesthesia and surgery. Anesthesiology. 1991;74:606–608
  3. Franklin CM, Rothenberg DM. Do-not-resuscitate orders in the presurgical patient. J Clin Anesth. 1992;4:181–184
  4. Mazur DJ, Hickam DH. Patient preferences for management of localized prostate cancer. West J Med. 1996;165:26–30
  5. Orentlicher D. The illusion of patient choice in end-of-life decisions. JAMA. 1992;267:2101–2104
  6. Wenger NS, Phillips RS, Teno JM, et al.  Physician understanding of patient resuscitation preferences (insights and clinical implications). J Am Geriatr Soc. 2000;48(5 Suppl):S44–51
  7. Eliasson AH, Parker JM, Shorr AF, et al.  Impediments to writing do-not-resuscitate orders. Arch Intern Med. 1999;159:2213–2218
  8. Clemency MV, Thompson NJ. Do not resuscitate orders in the perioperative period (patient perspectives). Anesth Analg. 1997;84:859–864
  9. Richter J, Eisemann MR. The compliance of doctors and nurses with do-not-resuscitate orders in Germany and Sweden. Resuscitation. 1999;42:203–209
  10. Casarett D, Ross LF. Overriding a patient’s refusal of treatment after an iatrogenic complication. N Engl J Med. 1997;336:1908–1910
  11. Casarett DJ, Stocking CB, Siegler M. Would physicians override a do-not-resuscitate order when a cardiac arrest is iatrogenic?. J Gen Intern Med. 1999;14:35–38
  12. Gaba DM, Howard SK, Jump B. Production pressure in the work environment (California anesthesiologists’ attitudes and experiences). Anesthesiology. 1994;81:488–500
  13. Thompson BL, Lawson D, Croughan-Minihane M, Cooke M. Do patients’ ethnic and social factors influence the use of do-not- resuscitate orders?. Ethn Dis. 1999;9:132–139
  14. Goetzler RM, Moskowitz MA. Changes in physician attitudes toward limiting care of critically ill patients. Arch Intern Med. 1991;151:1537–1541
  15. Kapp MB. Treating medical charts near the end of life: how legal anxieties inhibit good patient deaths. 28 U Tol L Rev 521 (1997)
  16. Liang BA. Assessing medical malpractice jury verdicts: a case study of an anesthesiology department. 7 Cornell J L & Pub Pol’y 121 (1997)
  17. Meisel A, Snyder L, Quill T. Legal barriers to end-of-life care (myths, realities, and grains of truth). JAMA. 2000;284:2495–2501
  18. Wendland v. Sparks, 574 N.W. 2d 327 (Iowa 1998)
  19. Causey v. St. Francis Med. Ctr., 719 S. 2d 1072 (La. Ct. App. 1998)
  20. HCA, Inc. v. Miller, No. 14-98-00582-CV (Tex Ct. App. 2000)
  21. Glasner v. Howick et al., 1997 WL 677955 (Tenn. App. Nov. 3, 1997)
  22. Anderson v. St. Francis-St. George Hospital Inc., 671 N. E. 2d 225 (1996)
  23. Randal Robb MJ. Living wills: The right to refuse life sustaining medical treatment—a right without a remedy? 23 Dayton L Rev 169 (1997)
  24. Peters PG Jr. The illusion of autonomy at the end of life: unconsented life support and the wrongful life analogy. 45 UCLA L Rev 673 (1998)
  25. Wilborn SE. The right to refuse medical treatment. Where there is a right, there ought to be a remedy. 25 N Ky L Rev 649 (1998)
  26. Milani AA. Better off dead than disabled? Should courts recognize a “wrongful living” cause of action when doctors fail to honor patients’ advance directives? 54 Wash & Lee L Rev 149 (1997)
  27. Crawford LS. Verdicts are controversial, contradictory; wrongful life cases (damned if you do, damned if you don’t). Med Malpractice Law Strategy. 1998;15:1
  28. A controlled trial to improve care for seriously ill hospitalized patients. The study to understand prognoses and preferences for outcomes and treatments (SUPPORT). The SUPPORT Principal Investigators. JAMA. 1995;274:1591–1598
  29. Margolis JO, McGrath BJ, Kussin PS, Schwinn DA. Do not resuscitate (DNR) orders during surgery (ethical foundations for institutional policies in the United States). Anesth Analg. 1995;80:806–809
  30. Bedell SE, Delbanco TL. Choices about cardiopulmonary resuscitation in the hospital (when do physicians talk with patients?). N Engl J Med. 1984;310:1089–1093
  31. Paris BE, Carrion VG, Meditch JS, Capello CF, Mulvihill MN. Roadblocks to do-not-resuscitate orders (a study in policy implementation). Arch Intern Med. 1993;153:1689–1695
  32. Curtis JR, Park DR, Krone MR, Pearlman RA. Use of the medical futility rationale in do-not-attempt-resuscitation orders. JAMA. 1995;273:124–128
  33. Hakim RB, Teno JM, Harrell FE, et al.  Factors associated with do-not-resuscitate orders (patients’ preferences, prognosis, and physicians’ judgments. SUPPORT Investigators. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment). Ann Intern Med. 1996;125:284–293
  34. Wenger NS, Pearson ML, Desmond KA, et al.  Epidemiology of do-not-resuscitate orders (disparity by age, diagnosis, gender, race, and functional impairment). Arch Intern Med. 1995;155:2056–2062
  35. Joint Commission on Accreditation of Healthcare Organizations: 2001 Comprehensive Accreditation Manual for Hospitals. Oakbrook Terrace, IL: Joint Commission on Accreditation of Healthcare Organizations, 2000
  36. Gaba DM, Fish KJ, Howard SK. Crisis Management in Anesthesiology. New York: Churchill Livingstone Inc; 1994;
  37. Clemency MV, Thompson NJ. “Do not resuscitate” (DNR) orders in the perioperative period - a comparison of the perspectives of anesthesiologists, internists, and surgeons. Anesth Analg. 1994;78:651–658
  38. Clemency MV, Thompson NJ. “Do not resuscitate” (DNR) orders and the anesthesiologist (a survey). Anesth Analg. 1993;76:394–401
  39. Truog RD, Waisel DB, Burns JP. DNR in the OR (a goal-directed approach). Anesthesiology. 1999;90:289–295
  40. Liang BA. Commentary on DNR in the OR (a goal directed approach). Surv Anesthesiol. 2000;44:189–190
  41. Emanuel EJ, Emanuel LL. Proxy decision making for incompetent patients. An ethical and empirical analysis. JAMA. 1992;267:2067–2071
  42. Uhlmann RF, Pearlman RA, Cain KC. Physicians’ and spouses’ prediction of elderly patients’ resuscitation preferences. J Gerontol. 1988;43:M115–121
  43. Seckler AB, Meier DE, Mulvihill M, Paris BE. Substituted judgment (how accurate are proxy predictions?). Ann Intern Med. 1991;115:92–98
  44. Mittelberger JA, Lo B, Martin D, Uhlmann RF. Impact of a procedure-specific do not resuscitate order form on documentation of do not resuscitate orders. Arch Intern Med. 1993;153:228–232

PII: S0952-8180(02)00401-4

Journal of Clinical Anesthesia
Volume 14, Issue 6 , Pages 467-473 , September 2002

Article Tools