DNR in the OR: Resuscitation as an Operative Risk
Walker, Robert M.
JAMA. 1991 Nov 6; 266(17): 2407-2412.
Should do-not-resuscitate (DNR) orders be routinely rescinded when terminally ill patients undergo palliative surgery? If so, patients will be forced to balance the benefits of palliative surgery against the risks of unwanted resuscitation. If physicians are required to honor intraoperative DNR orders, they may feel unacceptably restrained from correcting adverse effects for which they feel responsible. This dilemma has been overlooked by DNR policies. This article argues for the permissibility of honoring intraoperative DNR orders. The patient's right to refuse treatment outweighs physicians' concerns about professional scrutiny over intraoperative deaths. Physicians' moral concerns about hastening patient death are important but may be assuaged by (1) emphasizing patients' acceptance of operative mortality risk; (2) viewing matters as analogous to surgery on Jehovah's Witnesses who refuse lifesaving transfusion; (3) viewing the patient's intraoperative death as a double effect, that is, an unintended negative effect that is linked to the performance of a good act (palliation); and (4) distinguishing this from assisted suicide.
Advance Directives; Adverse Effects; Anesthesia; Assisted Suicide; Autonomy; Communication; Conscience; Consent; Death; Decision Making; Disease; DNR Orders; Double Effect; Drugs; Ethics; Extraordinary Treatment; Hospitals; Iatrogenic Disease; Institutional Policies; Jehovah's Witnesses; Life; Moral Policy; Mortality; Pain; Palliative Care; Patient Participation; Patients; Physicians; Policy Analysis; Presumed Consent; Resuscitation; Resuscitation Orders; Right to Die; Risk; Risks and Benefits; Standards; Suicide; Surgery; Terminal Care; Terminally Ill; Treatment Refusal; Trust; Withholding Treatment;
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Walker, Robert M. (1991-11-06)Should do-not-resuscitate (DNR) orders be routinely rescinded when terminally ill patients undergo palliative surgery? If so, patients will be forced to balance the benefits of palliative surgery against the risks of unwanted ...