Patients who have surgery often need routine interventions during anaesthesia that could be classed as resuscitation, points out Consultant Anaesthetist Dr Michael McBrien from the Royal Victoria Hospital in Belfast, Northern Ireland.
But automatically suspending DNAR Orders during surgery is no longer an acceptable option, according to Dr McBrien and his editorial co-author, Dr Gary Heyburn, Associate Specialist Orthogeriatrician at the Hospital.
"If the anaesthetist were to proceed and strictly obey the general understanding of a DNAR order under such circumstances, it could possibly be construed as an act of euthanasia or assisted suicide" they stress.
McBrien and Heyburn say that UK clinicians urgently need national guidance on how to manage the growing number of DNAR orders, pointing out that American guidelines have been in place since 1993.
"It is surprising that no guidelines or serious discussions on this matter have appeared in the UK to parallel the developments in North America" adds Dr McBrien.
The need for guidelines has been given added impetus by the fact that the Mental Capacity Act is due to come into force next year and that the European Convention on Human Rights is now enshrined in UK Law.
From 1 April 2007, the Act will give formal legal recognition to the patient's right to make advance decisions about the care they receive and reinforce the common law position about DNAR Orders that already exists.
"The paternalistic primary ethical principal of the past, namely immediate medical benefit to the patient, has been overtaken" says Dr McBrien.
"If we are not to face litigation in the future we must read, understand and implement what the law requires from
Contact: Annette Whibley
Blackwell Publishing Ltd.