Peri-Procedural Resuscitation: Dilemmas, Decisions, Documentation. Have We Made Progress?

Ethical controversies regarding resuscitation-related decisions in the peri-procedural setting continue to challenge healthcare teams, patients and their families. Achieving equitable and ethically grounded decisions is especially challenging due to the prognostic uncertainties, power dynamics and temporal pressures that accompany procedural interventions performed under anesthesia.
This session will bring together speakers from diverse disciplines and institutions to examine the intersection of clinical practice and healthcare ethics in the peri-procedural setting.
Panelists will draw from their clinical experience in adult and pediatric anesthesia, surgery, critical care, and palliative medicine as well as their expertise as ethicists, to describe historical perspectives, ongoing controversies, and emerging concerns regarding resuscitation-related decisions for patients having procedures under anesthesia.
The panel presentations will explore ethical dilemmas and practical challenges of decisions about resuscitation from provider and patient perspectives using case examples and literature review.
• How do potential benefits and harms of a procedure affect decision-making regarding peri-procedural resuscitation? What special considerations pertain to palliative and emergency procedures?
• How should healthcare teams ensure that patients and families are adequately informed and that their goals and values are respected?
• How can healthcare systems and providers collaborate to develop policies and procedures that will prompt clinicians to engage in the most ethically appropriate approach to peri-procedural management, to ensure goal-concordant healthcare?
• Is it ever ethically appropriate to unilaterally suspend pre-existing “DNAR” orders prior to a procedure, or alternatively, to refuse to perform a procedure for a patient who may not want any attempts at cardio-pulmonary resuscitation?