The patient's right to limit medical treatment, including refusing CPR (with a “do not resuscitate” [DNR] order) is firmly established in modern medical practice based on the ethical principle of respect for patient autonomy.
There are ethically sound arguments on both sides of the issue of whether DNR orders should be upheld in the operating room (OR).
A desire by the anesthesiologist or surgeon to suspend DNR orders during surgery is often based on the knowledge that nearly 75% of cardiac arrests in the OR are related to surgical or anesthetic complications and that resuscitation attempts are highly successful.
A mutual decision to suspend or limit a DNR order in the perioperative period may be achieved by communication among the patient, family, and caregivers.
Many interventions used commonly in the OR (mechanical ventilation, vasopressors, cardiac antidysrhythmics, blood products) may be considered forms of resuscitation in other situations. The only modalities that are not routine anesthetic care are cardiac massage and defibrillation.
Specific interventions included in a DNR status must be clarified with allowance made for methods necessary to perform anesthesia and surgery.