The Legal Ramifications and Ethics of DNR Orders

The summer edition of Ochsner Journal contains 2 complementary articles about do-not-resuscitate (DNR) orders: one article addresses the legal implications of advance directives in a variety of situations, and the other looks specifically at the ethical questions surrounding a patient who has a DNR order in place but is scheduled for surgery.

In this issue’s Bioethics in Practice column, Meredith Miceli from Ochsner’s legal department examines the concept of withdrawing vs withholding care and contrasts the advance directive laws in Texas and Louisiana. She emphasizes the importance of having a policy in place that not only complies with state law but also provides guidance for physicians when a patient’s DNR order or family’s wish directly conflicts with the doctor’s informed opinion as to what kind of care will provide benefit or cause harm to the patient.

In the second article, Dr. Sumrall and colleagues explain how the common perioperative requirement for cardiopulmonary resuscitation may violate a patient’s standing DNR order. After discussing the ethics principles of patient autonomy, nonmaleficence, beneficence, and distributive justice, the authors suggest that doctors meet with their patients prior to surgery to discuss in detail the resuscitative procedures that may be necessary throughout the surgery. With this approach, the patient has the opportunity to make decisions in advance regarding resuscitative care, and the surgical team is not placed in the position of potentially violating the patient’s wishes.

Together, these articles provide a strong argument for advance directives, as well as a thought-provoking discussion of some of the issues surrounding patient autonomy. For an additional perspective on DNR orders, read “DNR, DNAR, or AND? Is Language Important?” from the winter 2011 issue of Ochsner Journal.

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