Questions About DNR Orders

Bernard Lo, MD
JAMA. 1991;266(6):795. doi:10.1001/jama.1991.03470060056017.
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In Reply.  —We agree with Ventres and Nichter that physicians need to appreciate the concerns and images that patients and families have about cardiopulmonary resuscitation.Leivers raises the important issue of DNR orders in the operating room, particularly in patients undergoing palliative surgery. We agree that decisions about resuscitation in this setting need to be discussed before surgery and documented clearly. Furthermore, it would be appropriate to discuss before the operation what should be done if postoperative complications develop and cannot be successfully treated. Decisions should be individualized and should respect both the patient's preferences and the anesthesiologist's or surgeon's own ethical principles. As in this case, some mutually acceptable plan is usually possible. Our natural reaction as physicians to intervene, to try to correct iatrogenic illness, should be tempered if a patient chooses to forgo the maximum application of medical technology.


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