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From the Heart
March 8, 2023

Discussing Code Status鈥擝alancing Obligations to Respect Patient Autonomy While Avoiding Harm

Author Affiliations
  • 1Internal Medicine Residency, Mayo Clinic School of Graduate Medical Education, Rochester, Minnesota
JAMA Cardiol. 2023;8(5):413-414. doi:10.1001/jamacardio.2023.0062

鈥淲hat is the patient鈥檚 code status?鈥

After completion of my medical education in Ireland and with reluctancy to leave my new home, I remained for an additional 5 years of postgraduate clinical training prior to initiating residency in the United States. Adjusting to a new medical system was not as straightforward as I had anticipated. My residency experience started overnight on the hospital internal medicine service at a large academic medical center, and I quickly began to realize some key differences in respective approaches to patient care. After stumbling through my first admission, the electronic health record prompted me to document the patient鈥檚 code status. A stable patient with few comorbidities whom I did not expect to decompensate.

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2 Comments for this article
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"Life well lived" ... or still enjoying life?
Antony Hsu, MD | Trinity Health Ann Arbor, MI
As an emergency physician, I ask my patients' family members or legal designees if they feel the patient is still enjoying life most days before trying to change their code status from Full-code to DNR. I patiently explain that patients who don't enjoy life yet are kept alive by 'full-code' orders will unlikely develop a new enjoyment of life. Rarely do I meet family with unrealistic expectations after I give them a few minutes at the patient's bedside while phone conversations are much less accurate. In my career, I meet many cardiac arrest survivors and most have had excellent bystander CPR which I advocate for. In-house codes usually have different etiologies but their survival is also reasonably good when paired with monitoring and cardiac arrest champions who advocate realistic yet patient-centered policies.
CONFLICT OF INTEREST: None Reported
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A Vexing Problem
Scott Helmers, MD | Retired
A beautifully written and thoughtful essay. A friend recently required admission due to an allergic reaction. Being dutifully asked about code status, she was unnerved, thinking that her condition must be far more serious than portrayed if they were questioning whether she wished to be revived.
CONFLICT OF INTEREST: None Reported
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