• Matthew B Allen, Shahla Siddiqui, Omonele Nwokolo, Catherine M Kuza, Nicholas Sadovnikoff, David G Mann, and Michael J Souter.
• Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
• Anesthesiology. 2024 Sep 1; 141 (3): 584597584-597.

AbstractThe American Society of Anesthesiologists (ASA) opposes automatic reversal of do-not-resuscitate orders during the perioperative period, instead advocating for a goal-directed approach that aligns decision-making with patients' priorities and clinical circumstances. Implementation of ASA guidelines continues to face significant barriers including time constraints, lack of longitudinal relationships with patients, and difficulty translating goal-focused discussion into concrete clinical plans. These challenges mirror those of advance care planning more generally, suggesting a need for novel frameworks for serious illness communication and patient-centered decision-making. This review considers ASA guidelines in the context of ongoing transitions to serious illness communication and increasingly multidisciplinary perioperative care. It aims to provide practical guidance for the practicing anesthesiologist while also acknowledging the complexity of decision-making, considering limitations inherent to anesthesiologists' role, and outlining a need to conceptualize delivery of ethically informed care as a collaborative, multidisciplinary endeavor.Copyright © 2024 American Society of Anesthesiologists. All Rights Reserved.

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