Code status is defined as the type of treatment someone wants in an emergent situation. It is one of the most important questions you should consider in case you get sick and land in the hospital. You will probably be asked this same question several times during your hospitalization. Questions such as what would you like us to do in an emergent situation, or would you like us to do chest compression and intubation if your heart were to stop. These questions are there to help the healthcare professionals to tailor your treatment plan to what you want. Unfortunately, most people don’t think about death until they are sick or in a life-threatening accident. This leads to a significant healthcare burden and limits our ability to treat you with what you want. Here are some reasons you should think about goals of care even when you are young.
1. We don’t know what your goals of care are.
Imagine you come to the hospital in a coma and have never placed down the power of attorney, a wish, or shared your end-of-life decision with anybody. It will be difficult for healthcare providers to know how to treat you best. For example, patients may not want aggressive treatment plans like chest compression and intubation. Others may want everything to be done, regardless of their situation. There is also a subset of patients that would like conditional resuscitations. For example, they don’t want chest compressions and intubation but are okay with shocking the heart to restore unstable heart rhythms, or they are okay with medication that boosts the blood pressure. As a result, it is important to discuss with your medical providers to have your code status examined prior to hospitalization.
2. Your family doesn’t know your goals of care.
Most family members do not know what you want, despite being very close to you. This is one of the biggest things that we, as healthcare providers, struggle with. Most family members in cases of emergency defer the patient’s healthcare plan to full code, which means we do everything to save your life. But this may not be what you wanted. In some cases, your family dynamic could be a potential problem of ethics, meaning that part of your family wants everything to be done, but some families don’t. This can cause chaos, delay care, and ultimately harm your health. And the decision of your healthcare goals is often tied to financial incentives. It is therefore vital to think about your goals and discuss them with your family member. Better yet, you can designate a power of attorney, a designated person who knows you well enough and make that decision for you. They will make the healthcare decision in cases of emergency and help make the decisions you want.
3. If no one is found, we go to the default.
Many people may ask what happens when we, as medical providers, don’t know the patient’s goals of care. We often go to the default, which means full code. This means we will be doing everything for you, including CPR, chest compression, medication, electrical shocks, intubation, emergent surgery, and more. However, this does not mean that we cannot change that decision at a later time. Suppose a family member or the patient decides to change their care goals, this can happen at any time of their hospitalization. It is also important to note that if you choose to become DNR/DNI (do not resuscitate/ do not intubate), it does not necessarily mean that we won’t treat you the same. We will still give medications to make you feel comfortable and treat conditions that are not life-threatening. Therefore, you should not base your goals on the medical provider’s decision on a treatment plan. It should be based on your preferences and desire to be brought back in life-threatening situations.
Overall, discussing code status can be a challenging discussion for the patients and their loved ones. It is essential to educate the public on making that decision early, so in an emergent situation, we will know what to do that is best for you. Regardless of age, we should all think about what we want in these situations. Thank you so much for reading; if you enjoy content like this, please comment, like, and subscribe. Have a fabulous week, and we will talk again in the next post.
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