Perioperative do-not-resuscitate orders.
Recent advances in perioperative refusal of resuscitation center on goal-directed orders. Goal-directed orders permit patients to define perioperative resuscitation in terms of outcomes rather than procedures. A typical goal-directed order may state 'The patient desires resuscitative efforts during surgery and in the postoperative care unit only if the adverse events are believed to be both temporary and reversible, in the clinical judgment of the attending anesthesiologists and surgeons.' This review also discusses ways to use the ability to withdraw care as a way of honoring patients' wishes.
Waisel
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Department of Anesthesia, Children's Hospital, and Department of Anesthesia, Harvard Medical School, Boston, Massachusetts 02115, USA. Waisel@hub.tch.harvard.edu