BoardsBridgePatient Refuses: DNR/DNAR in the Operating Room
Autonomy persists at the OR door. Reconsider, do not abandon. Negotiate procedure-directed or goal-directed limits — never condition surgical access on rescission.
For a patient who continues a DNAR order before surgery, inform the patient or designated surrogate which procedures are essential to the anesthesia and proposed procedure and which are not essential and may be refused; do not require DNAR rescission as a condition of surgery.
If you forget
Reconsider, do not abandon — DNAR auto-suspension in the OR is wrong (ASA, ACS, AORN, TJC all agree).
Board trap
Key numbers
- 60% of anesthesiologists erroneously believe DNAR auto-suspends during anesthesia/surgery (Miller's Ch 7).
- 2013 — year ASA updated its DNR-in-OR guidelines (Box 28.10, Miller's Ch 28).
- 2006 — year orthopedic surgeons were successfully sued for requiring DNAR rescission as a condition of surgery (Miller's Ch 7).
Uri Rozen, MD — Licensed Physician, Israel
Source guidelines: Millers Anesthesia 10 Ch28 Preoperative Evaluation · Millers Anesthesia 10 Ch07 Ethical Aspects OF Anesthesia Care
Re-review cadence: 12 months from reviewed date.
Related on BoardsBridge
Card ID: patient-refuses · Path: aba.ethics.dnr-in-or.patient-refuses