Partial Codes—A Symptom of a Larger Problem

Abstract

sponsible, as thechaplainnoted, for theethical,moral, and financial debris of apartial code?The statewhoauthorized theuseof theadvance directive allowing a partial code? The hospital who permitted the partial code? The physicians? The patient? The family? All of the above? It’s an issue thatmerits further discussion, especially with an aging population in which resuscitative success declines,5 an ever-increasing use of life-prolonging medical technology that complicates theacceptanceofdeath, andnow,Medicare reimbursement for advance care discussions. So in theend,whenapatient survives apartial code, it canoften portendamessyandemotional futureforthefamilyaswellasthephysician,not tomention the financial repercussions for thehospital and family. As with Colorado’s advance directive, theMedical Orders for Scopeof Treatment (MOST) (http://coloradoadvancedirectives.com /wp-content/uploads/2014/07/1-MOST-Form-FINAL-2015.pdf) whichoffers thechoiceof full codeornocodewithnomenuofother options—perhaps codes should be an all or nothing event, not ”everything but intubation,” or “everything but cardioversion,” or “everything but intravenous medications,” or “everything but chest compressions.”Certainly, somewill arguesuchapolicy ispaternalistic and devoid of patient autonomy, but if the idea is to save a life and restorethepersontothe living,whywouldwenotperformafull code, even ifbriefandtime-limited, rather thanaresuscitative facade, such as chest compressionswithout intubation?