Whenever someone is admitted to the hospital, they are asked to stipulate their “code status.” Levels of code status include full code, meaning resuscitate and intubate if required; as well as various combinations of do not resuscitate (DNR) and do not intubate (DNI). In simple terms, a code status clarifies what you want the medical team to do in the event your heart stops or if your heart goes into a rhythm that is not compatible with life.
This question is often interpreted as follows: if you are about to die, do you want the medical team to do everything they possibly can to keep you alive? We might also allow ourselves to pose and interpret the question from a different perspective: If you are about to die, do you want permission to pass away peacefully?
When discussing code status with my patients, the answer I often get is, “Of course I want to live, do everything you can to save me.” TV and movies mistakenly portray emergency lifesaving measures working most of the time. In real life, attempts to resuscitate are not as successful. A review of more than 29 different studies involving 400,000+ people over the age of 70, show that only 19 percent survived to be discharged from the hospital. The odds were even worse for those in their 80s or 90s with survival rates of 15 percent and less than 12 percent, respectively. Of those who survived, less than half returned to the same status of living they enjoyed prior to the code. Most ended up not able to care for themselves independently.
Another common response I hear is, “Do everything if you think it will work.” Doctors are incredibly optimistic. We are trained to fight against the odds to save lives. Unfortunately, no one can predict the outcome of a code. That is like asking if a slot machine will win before we pull the lever. Sometimes we hit the jackpot and the person does fine, goes home, and everyone is happy and grateful. Other times, like most slot machines pulls, we are forced to admit the loss.
The best person to select your code status is you. There is no “right” answer, there is only your answer. Give yourself permission to make this decision with a calm, clear mind before you are in crisis or admitted to a hospital. It is not in your best interest to make a rushed decision. Nor is it fair to force it upon your loved ones in an emergency room as your health is rapidly declining.
It is okay to give yourself permission to change your answer over time as different circumstances arise. Share your answer with your family and your doctor. Then give yourself permission to be at peace with your answer.
Richard P. Holm, MD, passed away in March 2020 after a battle with pancreatic cancer. He is founder of The Prairie Doc. For free and easy access to the entire Prairie Doc library, visit www.prairiedoc.org and follow Prairie Doc on Facebook. Jill Kruse, D.O. is part of The Prairie Doc team of physicians and currently practices family medicine in Brookings, S.D.