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2 - Informed refusal – DNR orders in the patient undergoing anesthesia and surgery and at the end-of-life

from 1 - Consent and refusal

Published online by Cambridge University Press:  05 March 2012

Gail A. Van Norman
Affiliation:
University of Washington
Stephen Jackson
Affiliation:
Good Samaritan Hospital, San Jose
Stanley H. Rosenbaum
Affiliation:
Yale University School of Medicine
Susan K. Palmer
Affiliation:
Oregon Anesthesiology Group
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Summary

Do-not-resuscitate (DNR) orders may be written if cardiopulmonary resuscitation (CPR) would be physiologically futile, or at the request of patients who feel that CPR would result in poorer quality of life. Pre-hospital DNR policies have emerged recently and serve three primary purposes: to provide continued respect for patient autonomy following hospital discharge, prevent futile resuscitation efforts in the field, and protect the well-being of emergency medical service (EMS) personnel. This chapter explains this concept citing the case study of a 67-year-old male with oxygen-dependent COPD requiring a series of electroconvulsive therapies (ECT) for severe depression refractory to medical therapy. Patients with preexisting DNR orders often require anesthesia for surgical procedures necessitated by the need to improve quality of life. The American Society of Anesthesiologists and the American College of Surgeons have drafted guidelines for the management of the patient with a presurgical DNR order.
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Clinical Ethics in Anesthesiology
A Case-Based Textbook
, pp. 13 - 18
Publisher: Cambridge University Press
Print publication year: 2010

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