Reviewing ethical guidelines for the care of patients with Do-Not-Resuscitate orders after 30 years: rethinking our approach at a time of transition

Reviewing ethical guidelines for the care of patients with Do-Not-Resuscitate orders after 30 years: rethinking our approach at a time of transition
Anesthesiology; Matthew B. Allen, M.D.; Shahla Siddiqui, M.D., D.A.B.A., M.Sc.; Omonele Nwokolo, M.D.; Catherine M. Kuza, M.D.; Nicholas Sadovnikoff, M.D., H.E.C.-C.; David G. Mann, M.D., D.Be.; Michael J. Souter, M.B., Ch.B., D.A.; 9/24
The American Society of Anesthesiologists (ASA) opposes automatic reversal of do-not-resuscitate orders during the perioperative period, instead advocating for a goal-directed approach that aligns decision-making with patients’ priorities and clinical circumstances. Implementation of ASA guidelines continues to face significant barriers including time constraints, lack of longitudinal relationships with patients, and difficulty translating goal-focused discussion into concrete clinical plans. These challenges mirror those of advance care planning more generally, suggesting a need for novel frameworks for serious illness communication and patient-centered decision-making.