Despite a diagnosis of a terminal or life-limiting illness, a patient’s do not resuscitate (DNR) status does not preclude the right to surgical intervention. There are many instances when operative intervention is appropriate and warranted. Often a patient is already in the palliative phase of his or her advanced disease process when addressing perioperative DNR status becomes necessary. A standardized framework, rather than rigid policy, not only utilizes shared decision-making to achieve this goal, but also ultimately enables a just process for each individual patient. Such a framework should include requirements for reevaluation; clarification of responsibilities surrounding reevaluation; resuscitation options (full, goal directed, procedure directed, none); documentation requirements; time limitations; and resources.