Interventional radiologists (IRs) often care for critically ill patients, providing both treatment and palliation. For example, a recent study found that patients died within 30 days of 9% of inpatient image-guided procedures and within 6 months of 7% of outpatient image-guided procedures. It is also not uncommon for these patients to have do not resuscitate and/or do not intubate (DNR/DNI) orders or other advance directives expressing patients' wishes to refuse resuscitation and/or intubation in the event of a cardiac arrest or the loss of a protected airway. When asked to perform a procedure for these patients, IRs can face a few different ethical dilemmas: the patient may want to keep the DNR/DNI order in place for their procedure, the documented code status may conflict with patient or family preferences, or respecting such preferences in the face of a code can be disturbing for the IR and/or members of their team. This article considers each of these issues with suggestions of how to best navigate them.
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