TAILIEUCHUNG - Ethics review: Perioperative do-not-resuscitate orders – doing ‘nothing’ when ‘something’ can be done

Cardiopulmonary resuscitation (CPR) has the ability to reverse premature death. It can also prolong terminal illness, increase discomfort and consume enormous resources. Despite the desire to respect patient autonomy, there are many reasons why withholding CPR may be complicated in the perioperative setting. This review outlines these factors in order to offer | Available online http content 10 4 219 Review Ethics review Perioperative do-not-resuscitate orders - doing nothing when something can be done Mark Ewanchuk1 2 and Peter G Brindley2 1 Department of Anesthesiology and Pain Medicine University of Alberta Edmonton Alberta Canada 2Division of Critical Care Medicine University of Alberta Edmonton Alberta Canada Corresponding author Peter Brindley peterbrindley@ Published 3 July 2006 This article is online at http content 10 4 219 2006 BioMed Central Ltd Critical Care 2006 10 219 doi cc4929 Abstract Cardiopulmonary resuscitation CPR has the ability to reverse premature death. It can also prolong terminal illness increase discomfort and consume enormous resources. Despite the desire to respect patient autonomy there are many reasons why withholding CPR may be complicated in the perioperative setting. This review outlines these factors in order to offer practical suggestions and to provoke discussion among perioperative care providers. Although originally described for witnessed intraoperative arrests closed chest cardiac massage quickly became universal practice and a legal imperative in many hospitals. Concerns were raised by both health care workers and patient groups this eventually led to the creation of the do-not-resuscitate DNR order. However legal precedents and ethical interpretations dictated that patients were expected to receive full resuscitation unless there was explicit documentation to the contrary. In short CPR became the only medical intervention that required an order to prevent it from being performed. Before the 1990s patients routinely had pre-existing DNR orders suspended during the perioperative period. Several articles criticized this widespread practice and the policy of required reconsideration was proposed. Despite this many practical issues have hindered widespread observance of DNR orders for surgical patients including concerns related to the DNR .

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