Anesthetists Face Ethical Dilemmas

United Kingdom anesthetists could face accusations of euthanasia or assisted suicide if they follow "do not attempt resuscitation (DNAR)” orders during surgery, according to two UK doctors.

Patients who have surgery often need routine interventions during anesthesia that could be classed as resuscitation, but automatically suspending DNAR orders during surgery is no longer an acceptable option, according to an editorial in the July 2006 issue of Anaesthesia by consultant anesthetist Dr. Michael McBrien and orthogeriatrician Dr. Gary Heyburn, both of the Royal Victoria Hospital (RVH, Belfast, Northern Ireland).

According to Drs. McBrien and Heyburn, UK clinicians urgently need national guidance on how to manage the growing number of DNAR orders. They noted that guidelines in the United States have been in place since 1993. 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 in the United Kingdom, and that the European Convention on Human Rights is now enshrined in UK law. From April 1, 2007, the act will give formal legal recognition to the patients' rights 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 principle of the past, namely immediate medical benefit to the patient, has been overtaken,” said Dr. McBrien. "If we are not to face litigation in the future we must read, understand, and implement what the law requires from us in this area.”

Clinicians also need clear guidance about how to handle requests made by parents of sick children or relatives of patients not deemed legally competent. With individual clinicians facing increasing dilemmas on numerous fronts, the need for clear local and national guidelines has never been greater, concluded the authors.



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