OSCE stations › Reconsidering a DNR order before palliative surgery

Full access · Communication · Ethical issues: DNR, capacity, surrogates, refusal · 12 min

Reconsidering a DNR order before palliative surgery

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Mr. Leon Hartley, 71, has metastatic pancreatic cancer and has been vomiting for a week from gastric outlet obstruction. He is scheduled tomorrow for a palliative laparoscopic gastrojejunostomy under general anesthesia with a breathing tube. Six weeks ago, after talking with his oncologist, he signed a do-not-resuscitate order, which is in the chart. He is alert, oriented and has decision-making capacity. His wife is at home. The surgeon has asked you to see him before the case.

Your task: discuss with Mr. Hartley what his DNR order means for his anesthetic and surgery, and agree on a plan. Do not obtain general anesthetic consent. You have 8 minutes; a warning sounds at 6 minutes.³