Open Access Highly Accessed Research article

Patient and doctor attitudes and beliefs concerning perioperative do not resuscitate orders: anesthesiologists’ growing compliance with patient autonomy and self determination guidelines

Christopher M Burkle1*, Keith M Swetz2, Matthew H Armstrong1 and Mark T Keegan1

Author Affiliations

1 Department of Anesthesiology, Mayo Clinic, 200 First Street SW, Rochester, MN, USA

2 Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, USA

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BMC Anesthesiology 2013, 13:2  doi:10.1186/1471-2253-13-2

Published: 15 January 2013

Abstract

Background

In 1993, the American Society of Anesthesiologists (ASA) published guidelines stating that automatic perioperative suspension of Do Not Resuscitate (DNR) orders conflicts with patients’ rights to self-determination. Almost 20 years later, we aimed to explore both patient and doctor views concerning perioperative DNR status.

Methods

Five-hundred consecutive patients visiting our preoperative evaluation clinic were surveyed and asked whether they had made decisions regarding resuscitation and to rate their agreement with several statements concerning perioperative resuscitation. Anesthesiologists, surgeons and internists at our tertiary referral institution were also surveyed. They were asked to assess their likelihood of following a hypothetical patient’s DNR status and to rate their level of agreement with a series of non-scenario related statements concerning ethical and practical aspects of perioperative resuscitation.

Results

Over half of patients (57%) agreed that pre-existing DNR requests should be suspended while undergoing a surgical procedure under anesthesia, but 92% believed a discussion between the doctor and patient regarding perioperative resuscitation plans should still occur. Thirty percent of doctors completing the survey believed that DNR orders should automatically be suspended intraoperatively. Anesthesiologists (18%) were significantly less likely to suspend DNR orders than surgeons (38%) or internists (34%) (p < 0.01).

Conclusions

Although many patients agree that their DNR orders should be suspended for their operation, they expect a discussion regarding the performance and nature of perioperative resuscitation. In contrast to previous studies, anesthesiologists were least likely to automatically suspend a DNR order.

Keywords:
Do not resuscitate; Perioperative medicine; Patient decisions/choice