After nearly two decades of experience, the proper circumstances and procedures for implementing do-not-resuscitate (DNR) decisions have become a standard of care throughout our nation. This standard recognizes not only that cardiopulmonary resuscitation sometimes offers no benefit and may actually harm patients, but also that competent patients have a right to refuse it. Moreover, physicians have an obligation to discuss resuscitation status with patients and their families and to document those discussions and the resulting treatment plan in the medical record. In this issue of JAMA, Walker1 identifies one important area of clinical practice where the application of DNR policy remains problematic— the operating room.
At first glance, sending a DNR patient to the operating room may seem paradoxical. Yet, as Walker points out, terminal patients sometimes require palliative surgery. Furthermore, DNR patients need not be terminal; many of them live to leave the hospital
Youngner SJ, Cascorbi HF, Shuck JM. DNR in the Operating RoomNot Really a Paradox. JAMA. 1991;266(17):2433-2434. doi:10.1001/jama.1991.03470170121036