Live, Love & Let Go: A Doctor's Insightful Approach to Living and Dying by James Abshire MD

Author:James Abshire MD [Abshire MD, James]
Language: eng
Format: epub
ISBN: 9781581695274
Publisher: Evergreen Press
Published: 2014-04-17T07:00:00+00:00

13

Code Status and End-of-Life Decisions

In him and through faith in him, we may approach God with freedom and confidence. —Ephesians 3:12

This chapter will explore the practicalities, as well as the philosophy behind the medical code. Medical code status tells medical staff how aggressive to be in the event of a medical emergency, such as if the heart stops or the lungs fail. A “full code” status would mean that everything would be done in an emergent situation, including CPR and life support. Usually when CPR is performed, the patient will be put on life support at the same time. Life support involves the patient being intubated, meaning a tube is put down the throat into the airway, and a machine takes on the process of breathing for the patient.

A “no code blue” status means that CPR would not be performed and there would be no life support given. A “DNR” (Do Not Resuscitate) status refers to not using CPR or life support at all.

Adding to the options of potential codes is the concept of a “medicine only” code. In this scenario, only medicines are used to try to keep the patient alive. If the heart or lungs stop, there would be no CPR, no chest compressions, no electric shocks, and no intubation or breathing machines.

Another option is that of “comfort care” only. This would mean the status would be DNR, and medicines would not be used to try to prolong life. The medical goal in this scenario is to keep the patient comfortable but not to attempt to prolong their life. For instance, medicine would be given to alleviate symptoms such as pain or nausea, but medicine would not be given to correct an irregular life-threatening heart rhythm.

Before discussing decision-making, we need to establish who the decision-maker will be. If the patient is a competent adult, the decision-maker is the patient, possibly in collaboration with family/friends and with input from the doctor. However, we should all plan for the possible event in which we cannot speak for ourselves, such as if we have a loss of consciousness. This can be done by having appointed a trusted family member or friend to be the durable power of attorney for health care.

The health-care power of attorney can be the same person who is the power of attorney for financial affairs. However, it does not need to be the same person, and it is frequently a different person. For instance, you may decide to have your spouse be the durable power of attorney for health care, while having one of your children be in charge of financial affairs.

By filling out durable power of attorney for health-care papers, you have appointed someone to be your spokesperson, in case you cannot speak for yourself. You can also appoint an alternate decision-maker in case the primary contact is unavailable. These papers are generally available at your doctor’s office or hospital, or can be pulled off the Internet. You will need to either have two witnesses sign them or have them notarized.

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