• Question: My hospital routinely suspends pre-existing Do Not Resuscitate/Do Not Intubate (DNR/DNI) directives while patients undergo ophthalmic surgeries. I doubt patients are aware of this action. I’m concerned and wonder if it is ethical?

    Answer: The question of DNR/DNI directives during ophthalmic surgery should be looked at as a patient autonomy issue. Patient autonomy allows health care providers to educate patients but does not allow providers to make decisions for patients. Like any part of the informed consent process, it is important to discuss this question with the patient or surrogate prior to any surgical procedure.

    The American Medical Association holds that automatic suspension of DNR orders cannot be justified as it denies patient autonomy.1 Additionally, the practice may violate the Patient Self-Determination Act of 1990.2

    Educating patients on this issue would be a significant time commitment since this is not a delegable duty. Perhaps simply asking all patients 1) if they have a DNR, and 2) in the absence of a DNR, whether or not they desire full resuscitation, would enable patient decision-making and address this issue from an ethical and risk management perspective for the physician and hospital. Of course, documenting everything in the medical record is of utmost importance.

    To submit a question, reach out to the Ethics Committee at ethics@aao.org.

    1 www.journalofethics.ama-assn.org/article/perioperative-do-not-resuscitate-orders/2015-03. Accessed Aug. 14, 2020
    2 www.congress.gov/bill/101st-congress/house-bill/4449. Accessed Aug. 14, 2020