Conversations About Treatment at the End of Life

Abstract

Conventional wisdom in medicine maintains that most physicians, certainly those experienced in talking with patients or their proxies about code status, can profoundly influence the outcome of code status discussions. While there may be few if any studies to substantiate the conventional wisdom, there are probably more than a few grains of truth to it. The study by Downar and colleagues1 provides interesting insights into the thoughts and perspectives of patients who have elected either a “full code” (FC) or “do not resuscitate” (DNR) status, enhancing information gleaned from the dearth of earlier studies. Previous observations indicate that the likelihood of a patient opting for a “full code” status drops dramatically when the patient is fully apprised of the prognosis, especially when life expectancy is less than 6 months.2 Also influential in decreasing a patient’s desire for FC status is that the patient understands that cardio-pulmonary resuscitation (CPR) is unlikely to successfully restore them to an acceptable minimum level of function and quality of life.3