title: Advance directives in the perioperative setting: Managing ethical and legal issues when patient rights and perceived obligations of the healthcare provider conflict.
abstract: Perhaps individual wishes are not always acknowledged or accepted when it comes to end-of-life care. This possibility, in conjunction with the experiences of healthcare risk managers, should cause concern in the healthcare risk management community. One particularly concerning issue where a persistent failure to honor a patient's wishes exists is with Do Not Resuscitate (DNR) orders in the perioperative arena. Despite a strong focus on informed consent and advance directives, evidence suggests a number of healthcare organizations either have no policy in place regarding DNR orders during the perioperative period, or, for those organizations that do have a policy, many call for automatic suspension of the DNR order without consultation with the patient. This latter practice poses many ethical, medico-legal, and regulatory concerns, and healthcare organizations with such a policy in place should strongly consider revisiting this practice.
authors.affiliation: Haynsworth Sinkler, Boyd, PA, USA.
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Williams
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Howe
mesh_terms: D016223:Advance Directives / Q000941:ethics* / Q000331:legislation & jurisprudence*; D034462:Dissent and Disputes; D006282:Health Personnel / Q000941:ethics / Q000331:legislation & jurisprudence; D006801:Humans; D028701:Patient Rights / Q000941:ethics / Q000331:legislation & jurisprudence; D019990:Perioperative Care / Q000941:ethics / Q000331:legislation & jurisprudence; D016414:Resuscitation Orders / Q000941:ethics / Q000331:legislation & jurisprudence; D012308:Risk Management / Q000941:ethics / Q000331:legislation & jurisprudence; D013727:Terminal Care / Q000941:ethics / Q000331:legislation & jurisprudence; D014481:United States