Summary
The status of DNR orders (or equivalent declarations) in patients undergoing surgery will continue to present considerable challenges for both healthcare providers and patients, or their alternate decision makers. It is essential that all parties understand the specifics of each DNR order, focusing not only on the actual content of the order or declaration but also on the context in terms of location, timing and circumstance. The principle of “respect for persons” should guide, inform and shape the approach followed with each patient. Meaningful dialogue and “negotiation” will be required.
Make no assumptions! The “required reconsideration” of pre-existing DNR orders should be the basic approach followed. There is no single “solution” for all DNR-related issues in the peri-operative period. What may appear obvious to the anaesthetist may be viewed entirely differently by the patient, or even by other members of the care giving team. There is no justification for either the automatic suspension or the automatic continuation of DNR orders in patients undergoing surgery. A patient-specific and situationspecific approach and “solution” is required. Similar principles will apply in acute care settings other than the operating room. Full engagement by health care workers in the processes addressing these issues should be a personally enriching experience.
Résumé
Le problème des prescriptions NPR (ou leur équivalent) pour les patients qui vont être opérés va continuer de présenter des défis importants à la fois aux personnel soignant et aux patients, ou à ceux qui prennent les décisions en leur nom. Il est essentiel que toutes les parties comprennent les particularités de chaque prescription NPR, en se concentrant non seulement sur le contenu présent de la prescription ou de la déclaration mais aussi sur le contexte en termes de localisation, temps et circonstances. Le principe du «respect de la personne» devrait guider, informer et ajuster l’approche que l’on adopte pour chaque patient. Un dialogue sérieux et une «négociation» seront nécessaires. a
Ne faites pas d’hypothèses! La «réévaluation obligatoire» d’une prescription NPR préexistante devrait être l’approche principale à suivre. Il n’y a pas de «solution» unique pour tous les problèmes en rapport avec les prescriptions NPR durant la période périopératoire. Ce qui peut apparaître évident à un anesthésiste peut être perçu complètement différemment par le patient, ou même par d’autres membres de l’équipe soignante. Il n’y a aucune justification pour la suspension automatique ou la poursuite automatique des prescriptions NPR des patients devant être opérés. Une approche et une «solution» spécifique à chaque patient et à chaque situation sont nécessaires. Des principes similaires s’appliquent dans des unités de soins aigus autres que la salle d’opération. Un engagement total du personnel soignant dans la résolution de ces problèmes devrait être une expérience personnelle enrichissante.
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Craig, D.B., Webster, G.C. Do not resuscitate orders — managing the dilemma. Can J Anaesth 45 (Suppl 1), R160–R171 (1998). https://doi.org/10.1007/BF03019216
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DOI: https://doi.org/10.1007/BF03019216