This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (50)  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Social Bookmarking   What's this?

Resuscitation as an Operative Risk

Robert M. Walker, MD

JAMA. 1991;266(17):2407-2412.

Abstract
Should do-not-resuscitate (DNR) orders be routinely rescinded when terminally ill patients undergo palliative surgery? If so, patients will be forced to balance the benefits of palliative surgery against the risks of unwanted resuscitation. If physicians are required to honor intraoperative DNR orders, they may feel unacceptably restrained from correcting adverse effects for which they feel responsible. This dilemma has been overlooked by DNR policies. This article argues for the permissibility of honoring intraoperative DNR orders. The patient's right to refuse treatment outweighs physicians' concerns about professional scrutiny over intraoperative deaths. Physicians' moral concerns about hastening patient death are important but may be assuaged by (1) emphasizing patients' acceptance of operative mortality risk; (2) viewing matters as analogous to surgery on Jehovah's Witnesses who refuse lifesaving transfusion; (3) viewing the patient's intraoperative death as a double effect, that is, an unintended negative effect that is linked to the performance of a good act (palliation); and (4) distinguishing this from assisted suicide.

(JAMA. 1991;266:2407-2412)

Author Affiliations
From the Division of Medical Ethics and Humanities, Department of Internal Medicine, University of South Florida College of Medicine, Tampa.

Footnotes
The views expressed herein are those of the author and do not necessarily represent those of the supporting institution.

Reprint requests to University of South Florida College of Medicine, Department of Internal Medicine, Division of Medical Ethics and Humanities, 12901 Bruce B Downs Blvd, MDC Box 19, Tampa, FL 33612-4799 (Dr Walker).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Superseding Psychiatric Advance Directives: Ethical and Legal Considerations
Swanson et al.
J Am Acad Psychiatry Law 2006;34:385-394.
ABSTRACT | FULL TEXT  

Beyond Advance Directives: Importance of Communication Skills at the End of Life
Tulsky
JAMA 2005;294:359-365.
ABSTRACT | FULL TEXT  

Do-Not-Resuscitate Orders for Pediatric Patients Who Require Anesthesia and Surgery
Fallat et al.
Pediatrics 2004;114:1686-1692.
ABSTRACT | FULL TEXT  

Informed Consent and Advance Directives
Baruch
J. Am. Podiatr. Med. Assoc. 2004;94:198-205.
ABSTRACT | FULL TEXT  

CPR for Patients Labeled DNR: The Role of the Limited Aggressive Therapy Order
Choudhry et al.
ANN INTERN MED 2003;138:65-68.
ABSTRACT | FULL TEXT  

Do Not Resuscitate
Berlin
Am. J. Roentgenol. 2000;175:1513-1517.
FULL TEXT  

Do-Not-Resuscitate Orders in Radiology Departments
Heffner
ANN INTERN MED 1999;131:73-73.
FULL TEXT  

Ethical Issues in the Postoperative Intensive Care Unit
Baldyga
SEMIN CARDIOTHORAC VASC ANESTH 1998;2:90-98.
ABSTRACT  

Improved Survival After Intraoperative Cardiac Arrest in Noncardiac Surgical Patients
Girardi and Barie
Arch Surg 1995;130:15-18.
ABSTRACT  

Ethical Considerations in Resuscitation
JAMA 1992;268:2282-2288.
ABSTRACT  

Anesthesiology
Barash
JAMA 1992;268:335-337.
ABSTRACT  

DNR in the OR
Couper
JAMA 1992;267:1465-1465.
ABSTRACT  

DNR in the OR
Truog et al.
JAMA 1992;267:1466-1466.
ABSTRACT  

DNR in the OR
Franklin and Rothenberg
JAMA 1992;267:1465-1466.
ABSTRACT  

DNR in the Operating Room: Not Really a Paradox
Youngner et al.
JAMA 1991;266:2433-2434.
ABSTRACT