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Questions About DNR Orders FREE

LCDR David Leivers, MC
[+] Author Affiliations

Supported by the United States Navy, Clinical Investigation Program report No 84-16-1968-278.

The views expressed in this letter are those of the author and do not reflect the official policy or position of the Department of the Navy, Department of Defense, or the US government.


JAMA. 1991;266(6):795-795. doi:10.1001/jama.1991.03470060056016
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To the Editor.  —The recent update of the cardiopulmonary resuscitation guidelines1 and editorial comment2 are welcome as further developments in this complicated and evolving area. However, many specific problems were not addressed. Truog3 reviewed the question of the status of DNR orders in patients undergoing surgery and anesthesia. For anesthesiologists, there are special and frequently conflicting aspects of providing care during palliative surgery. The following case highlights this dilemma:A 54-year-old man with endstage amyotrophic lateral sclerosis presented for gastrostomy. He was fully alert but confined to a wheelchair. He lived at home with his caring wife. His profound weakness did not permit coordinated swallowing, and his decline was being accelerated by malnutrition. Respiratory reserve was negligible with PaO2 of 56 mm Hg breathing air and PaCO2 of 54 mm Hg. In a discussion prior to the procedure, the patient and his wife revealed an

REFERENCES

Council on Ethical and Judicial Affairs.  Guidelines for the appropriate use of do-not-resuscitate orders. JAMA . 1991;;265:1868-1871.
Lo B.  Unanswered questions about DNR orders. JAMA . 1991;;265:1874-1875.
Truog RD.  Do-not-resuscitate orders during anesthesia and surgery. Anesthesiology . 1991;;74:606-608.

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Council on Ethical and Judicial Affairs.  Guidelines for the appropriate use of do-not-resuscitate orders. JAMA . 1991;;265:1868-1871.
Lo B.  Unanswered questions about DNR orders. JAMA . 1991;;265:1874-1875.
Truog RD.  Do-not-resuscitate orders during anesthesia and surgery. Anesthesiology . 1991;;74:606-608.
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