title: Palliative surgery in the do-not-resuscitate patient: ethics and practical suggestions for management.
abstract: Palliative care in the United States has made tremendous strides in the last decade. One of the most perplexing issues arises when a palliative care patient presents to the operating room with an already existing do-not-resuscitate (DNR) order. This article describes the most common conflicting issues that may arise and provides guidance to surgeons, anesthesiologists, patients, and their primary physicians to reach satisfactory resolution and optimal care. Anesthesia departments should appoint a liaison to surgical and perioperative nursing departments to provide education and create an atmosphere conducive to discussions with palliative care patients about goals of care, including DNR status.
authors.affiliation: Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, 19104, USA. Thomas.Scott2@uphs.upenn.edu
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Scott
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Gavrin
mesh_terms: D000368:Aged; D016887:Cardiopulmonary Resuscitation; D005260:Female; D017051:Hospice Care; D006801:Humans; D010166:Palliative Care / Q000941:ethics*; D011183:Postoperative Complications / Q000628:therapy; D016414:Resuscitation Orders / Q000941:ethics*; D013514:Surgical Procedures, Operative