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Palliative Care

One-Hour Concurrent Session

DNAR Orders and Invasive Procedures: A Multidisciplinary Approach to Ethical Management

Thursday, April 21, 2022

2:00 PM – 3:00 PM US CST

CE: 1.0

Concurrent Session Moderator(s)

Mary Faith Marshall, HEC-C, PhD, FCCM

Director, Center for Health Humanities and Ethics
University of Virginia School of Medicine
Charlottesville, VA

No relevant financial relationship(s) to disclose
Preeti John, HEC-C, MD, MPH, FCCM

Surgeon, Intensivist, Integrated Ethics Program Director
Veterans Affairs Maryland Health Care System - Baltimore Division
Baltimore

No relevant financial relationship(s) to disclose

There is ongoing confusion about appropriate management of patients with preexisting do-not-resuscitate (DNR) orders who present for procedures to the ICU, procedural suites, and operating room. Does the order to limit resuscitation need to be revoked before the procedure? Is it possible to perform procedures while the DNR order is retained? Four societies have published guidelines that have been in place for more than 15 years, yet there is still debate about ethical management of such patients. As the population ages, more intensivists, anesthesiologists, and clinicians who perform invasive procedures will encounter such situations and will need to be aware of appropriate management. Clinicians should be comfortable conducting appropriate discussions. In the context of the COVID-19 pandemic, communication challenges have made discussions about this topic even more challenging. Speakers will present challenges faced by anesthesiologists, surgeons, intensivists, and nurses and discuss what is ethically appropriate in various scenarios.

Learning Objectives:

Review existing guidelines for ethical management of adult patients with preexisting do-not-resuscitate (DNR) orders who present for procedures under anesthesia
Conduct and document goals-of-care conversations in the periprocedural and ICU environment
Categorize the use of life-sustaining treatments during routine care versus during deterioration and cardiac arrest

Presentations:

Patients with Preexisting DNAR Orders: Periprocedural Management in the ICU and OR
Concurrent Session Faculty: Preeti R. John, HEC-C, MD, MPH, FCCM – Veterans Affairs Maryland Health Care System - Baltimore Division
Ethical Considerations: In-Hospital Management of Patients Who Wish to Limit CPR From a Nursing Perspective
Concurrent Session Faculty: Mary Faith Marshall, HEC-C, PhD, FCCM – University of Virginia School of Medicine
Periprocedural Management of Patients With a DNAR Order: Challenges Faced by Anesthesiologists
Concurrent Session Faculty: Rebecca A, Aslakson, MD, PhD – Stanford University