This paper reviews the advent of unilateral do-not-resuscitate orders. Unilateral do-not-resuscitate policies presume that cardiopulmonary resuscitation is a medical therapy and that physicians have no obligation to undertake a medical therapy that does not offer achievable and appropriate goals. Four do-not-resuscitate policies from U.S. hospitals and some of the significant published proposals are reviewed. We conclude that anything other than a physiologic definition of futility is indefensible because of imposed value judgments, imprecise definitions of quantitative and qualitative futility, inexact data, lack of certitude of economic benefit, and the role of autonomy for the patient and physician.

Consensus↗

PubMed1995

The benefits of the explanation of the risks of anesthesia in the day surgery patient.

STUDY OBJECTIVE: To ascertain the benefits of the preoperative discussion of the risks of anesthesia with parents of ASA status I or II pediatric day surgery patients. DESIGN: Survey analysis. SETTING: Pediatric day surgery unit. PATIENTS: 54 parents of ASA status I or II pediatric day surgery patients between the ages of 7 months and 16 years. INTERVENTIONS: After informed consent for the anesthetic was obtained by a member of the anesthesiology team, the parent(s) were given a questionnaire on their feelings about the explanation of the risks of anesthesia. MEASUREMENTS AND MAIN RESULTS: The questionnaire evaluated how parents felt about their understanding of the risks of anesthesia, the effect of hearing the risks of anesthesia on their anxiety levels, and the benefits of hearing the risks of anesthesia. Over 90% of the parents felt that they understood the risks of anesthesia, that the discussion of the risks would have no effect on their decision to proceed with surgery, and that the explanation of the risks is desirable; 92% considered the explanation desirable either out of a sense of responsibility or because they welcomed better understanding. CONCLUSIONS: Our study suggests the benefits of the explanation of the risks of anesthesia appear to be rooted in satisfying parental responsibility and understanding, and not in providing information for decision making or anxiety relief. Anesthesiologists should not feed compelled to always detail all the risks, but should seek to satisfy individual parental needs.

Adolescent↗

PubMed1995

PEFIOS: an expert closed-loop oxygenation algorithm.

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Algorithms↗