Required reconsideration of "do-not-resuscitate" orders in the operating room and certain other treatment settings.

Abstract

It is time to change the assumption that DNR orders apply in every treatment setting in the hospital. It is appropriate to mandate not only that these orders be reconsidered on the basis of time, but also on the basis of setting. When patients enter treatment settings in which discrete, time-limited therapies that can precipitate cardiac arrest are offered, they or their surrogates should reconsider the question of resuscitation with their current and primary physicians. While this will make patient transition from one hospital setting to another more complicated, it will allow patients to receive treatment directed toward their individual needs, immediate treatment objectives, and long-term treatment goals. It will also assure health care professionals that they will not be required to withhold treatment essential for meeting patients' treatment objectives in these settings.