Perioperative DNR Orders, Palliative Surgery, and Ethics

Do-not-resuscitate (DNR) orders and implementation vary among institutions. Without clear documentation and communication, DNR orders may be a source of misunderstanding among health care team members. A DNR order must be clearly defined so that patients, family members, and the health care team understand patient wishes if a life-threatening event occurs. A DNR order does not mean that patients are “giving up” or refusing treatment to make their life more comfortable or improve their quality of life. A DNR order identifies the decision of a patient and care team regarding cardiopulmonary resuscitation during a life-ending event. Often patients who have a DNR order may require palliative surgical intervention; this may present a challenge for nurses caring for a patient. This article discusses the ethical issues and methods of respecting DNR work orders for patients undergoing surgery and the role of palliative surgery in addressing quality of life and care issues.