Ethics in Practice   |    
Advance Directives and Resuscitation Issues in the Care of Patients in Orthopaedic Surgery
Rosemarie Mannino, MD1; Wilhelm Zuelzer, MD1; Candice McDaniel, MD1; Laurel Lyckholm, MD1
1 Division of Hematology/Oncology and Palliative Care, Department of Internal Medicine (R.M. and L.L.), P.O. Box 980230, and Department of Orthopaedic Surgery (W.Z. and C.M.), P.O. Box 980153, Virginia Commonwealth University, Richmond, VA 23298-0153. E-mail address for R. Mannino: rmannino@mcvh-vcu.edu
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Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2008 Sep 01;90(9):2037-2042. doi: 10.2106/JBJS.G.00779
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A sixty-two-year-old woman was admitted to the hospital because of an inability to walk secondary to severe pain in the left hip as well as a large, fungating infiltrating ductal carcinoma of the breast. Computed tomography demonstrated multiple areas of osseous metastases. The left femoral neck and acetabulum were at risk for impending fracture. In discussing the diagnosis, prognosis, and treatment with the patient, she indicated that she wanted treatment that would slow and palliate the cancer, including chemotherapy and hormonal therapy. She did not wish for cardiopulmonary resuscitation or mechanical intubation to be performed. A do-not-resuscitate order was entered in her chart. However, she agreed to surgery and radiation therapy to stabilize the metastatic lesion in the femur, since it could improve her mobility and her overall quality of life.
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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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