Clinicians also need clear guidance about how to handle requests made by parents of sick children or relatives of patients not deemed legally competent.
"Usually agreement will be reached about whether cardiopulmonary resuscitation should be attempted if the patient suffers respiratory or cardiac arrest" says Dr McBrien.
"If disagreement persists despite attempts to reach agreement, legal advice should be sought.
"Parents cannot require doctors to provide treatment contrary to their professional judgement, but doctors will try to accommodate parents' wishes as far as is compatible with protecting the child's interest."
With individual clinicians facing increasing dilemmas on numerous fronts the need for clear local and national guidelines has never been greater.
"A review of the basic ethical principles involved is needed to decide how individual anaesthetists and anaesthetic departments in the UK should manage this situation" conclude the authors.
"Dr McBrien and Dr Heyburn have done patients a service in stimulating discussion about the relationship between modern and often quite complex - DNAR orders and the interventions required during anaesthesia" says the Journal's Editor-in-Chief Dr David Bogod, Consultant Anaesthetist at Nottingham City Hospital, UK.
"The issue actually extends to wider aspects of medical practice by anaesthetists, including intensive and palliative care. While individual autonomy in these cases is often best served by a sensitive and detailed exploration of the patient's wishes by the doctors caring for them, it might be that some national guidance is needed.
"The Council of the Association of Anaesthetists of Great Britain and Ireland have advised us that they are actively considering setting up a working party for this purpose."
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Contact: Annette Whibley
wordwizard@clara.co.uk
Blackwell Publishing Ltd.
28-Jun-2006