Do Not Attempt Resuscitation (DNAR) Decisions in the ... - aagbi

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At the end of the decision making process patients, proxy decision makers, relatives, carers, friends and IMCAs (if indicated) should feel that they have received adequate information in a form they can understand and that the decisions taken truly reflect the wishes of the patient. Further information on decisions relating to CPR has been published by the British Medical Association [20], but the issue of DNAR decisions in the perioperative period is not considered. If patients feel they have not had the chance to have a proper discussion with the healthcare team, or are not happy with the discussions they have had, they should be given the option of a consultation with other designated individuals within each hospital. 24
11. References 1. American Society of Anaesthetists Committee on Ethics, 2001. Ethical guidelines for the anesthesia care of patients with do-notresuscitate orders or other directives that limit treatment. www. asahq.org/publicationsAndServices/standards/09.html (accessed 01/08/08). 2. Canadian Anesthesiologists’ Society Committee on Ethics, 2002. Peri-operative status of ‘do not resuscitate’ (DNR) orders and other directives regarding treatment. www.cas.ca/members/ sign_in/guidelines/do_not_resuscitate/ (accessed 01/08/08). 3. Resuscitation Council, Decisions Relating to Cardiopulmonary Resuscitation. A Joint Statement from the British Medical Association, the Resuscitation Council (UK) and the Royal College of Nursing, London: 2007. www.resus.org.uk/pages/DNAR.htm (accessed 18/11/08). 4. McBrien ME and Heyburn G. Anaesthesia 2006; 61: 625–7. 5. Consent for Anaesthesia, 2nd edition 2006. London, The Association of Anaesthetists of Great Britain and Ireland. www. aagbi.org/publications/guidelines/docs/consent06.pdf (accessed 01/08/08). 6. General Medical Council. Consent: patients and doctors making decisions together, 2008. www.gmc-uk.org/news/articles/ Consent_guidance.pdf (accessed 01/08/08). 7. Medical Council of Ireland. A Guide to Ethical Conduct and Behaviour, Sixth Edition, 2004. www.medicalcouncil.ie/ professional/ethics.asp (accessed 18/11/08). 8. Mental Capacity Act 2005. http://www.opsi.gov.uk/ACTS/ acts2005/ukpga_20050009_en_1 (accessed 29.1.09). 9. Adults with Incapacity (Scotland) Act 2000. http://www.opsi.gov. uk/legislation/scotland/acts2000/asp_20000004_en_1 (accessed 29.1.09). 25
Page 1 and 2: Do Not Attempt Resuscitation (DNAR)
Page 3 and 4: Contents Section 1 Recommendations
Page 5 and 6: 7. The law provides a clear hierarc
Page 7 and 8: none have been published in the UK
Page 9 and 10: Proxy decision makers Within these
Page 11 and 12: 5. Legal framework United Kingdom T
Page 13 and 14: Who can implement a DNAR decision?
Page 15 and 16: patient if they lack capacity. Howe
Page 17 and 18: If the anaesthetist was to proceed
Page 19 and 20: Preoperative phase Provision must b
Page 21 and 22: The patient may wish to undergo a m
Page 23 and 24: c) The senior clinician in charge o
Page 25: 10. Summary for patients, proxy dec
Page 29 and 30: 20. British Medical Association. Ca
Page 31 and 32: 4. The use of electrical cardiovers
Page 33: AND signature of clinician in charg

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