LAUSR

In 1990, the passing of the Patient Self-Determination Act by Congress has federally mandated healthcare organizations reimbursed by the Centers for Medicare & Medicaid Services to discuss advanced directives with patients and/or their surrogates. Respect for these healthcare consumers' autonomous decisions related to the acceptance or refusal of treatment and care must be addressed within the advanced directives. One of the autonomous decisions is the do-not-resuscitate (DNR) order, which is a medical and legal document that reflects a patient's decision to withhold life-sustaining interventions in the event of a cardiac and/or respiratory arrest. Healthcare organizations accredited by the Joint Commission are required to have policies in place addressing patients' advanced directives and resuscitative status. It is not uncommon that patients admitted to hospitals with active DNR orders require surgical interventions and a DNR order does not equate to “do not treat.” In addition, it has been reported that approximately 15% of patients with active DNR orders undergo surgical palliative interventions. Despite recommendations and guidelines by professional perioperative and anesthesia organizations advocating and supporting the discussions of the preexisting DNR orders before surgical interventions between patients/ surrogates and providers, such practice has not been fully embraced. Institutional policy has also continued to support the automatic suspension of DNR order as a standard practice before surgeries. The argument has been made that the nature of the surgical intervention may justify the