Do-Not-Resuscitate Orders in the Operating Room

Case Synopsis

An 86-year-old woman presents as an add-on operating room case late one afternoon for treatment of a hip fracture suffered in a fall at home. She lives independently with home assistance. She is clearly competent and articulate and states that she is a “DNR” and does not want resuscitation measures in the operating room if her “heart stops.” She reasons that her likelihood of returning to independence in the event of a cardiac arrest is small, and she does not want to risk long-term disability. The anesthesiologist and orthopedic surgeon demand that she suspend her DNR for the surgery. She refuses. Finally, the anesthesiologist states that he will not anesthetize her unless she suspends her DNR because being able to resuscitate her is “a necessary part of the anesthesia.” Ultimately, she angrily agrees to the suspension of her DNR. The surgery is uneventful.