When is the appropriate time to make the change from being “full code” to being “no code”? Full code means that when your heart stops, and you have died, medical professionals or paramedics will do everything medically possible to try and restart your heart. No code means that if your heart stops, medical professionals or paramedics will NOT try to restart your heart. They will let a person stay dead. They will not intervene and try to bring them back.
This sounds very harsh so let's explore this idea further. We are conditioned to think that a call to 911 can help us no matter what the emergency is and to think that the doctors will always be able to "fix" me.
Because everyone dies, whether or not we want to admit it, there will come a point when the medical system will "fail" us. It will be our time to die. When the doctors have said, "I can't fix you" it is time to reconsider what medicine can do for us.
Medicine and medical technology can prolong our life but not indefinitely and it is generally at the expense of our quality of living. Or we can reframe how we think of medicine, using it as a tool to provide comfort, dignity and support as our final life experience unfolds.
If I stuck my finger in a light socket and my heart stopped, I would want you to call 911. The paramedics could probably restart my heart and I would return to my normal life and activities.
If my body is filled with a disease that the doctors have said they cannot fix, my heart stops, and I do not have a No Code order or DNR, DNAR form completed and signed by a physician, the paramedics or doctors are bound by their profession to try to start my heart again. And they may succeed BUT in most cases I will not be as able as I was before my heart stopped. My disease will still be non-fixable. I will die again in a short time.
And in that short time there will be continued decline of my body, continued progression of the disease, the pain will remain and there may be increased pain from fractured bones due to the resuscitation efforts.
Life will have less quality. What is quality? Is it heart beating, lungs exchanging air, kidneys working all with the help of machines, quality? OR is quality thinking, feeling and interacting? Something to think about.
Something More About... Do I Want FULL CODE or a NO CODE?
Pages 12-15 of BY YOUR SIDE, A Guide for Caring for the Dying at Home, covers end of life decisions that need to be made before they are needed. POLST, Advance Directives, DNR, DNAR and Durable Power of Attorney information is laid out clear ways.
10 comments
Christy
I feel like we should already know each other well. You have helped me through the passing of my great grandmother, my niece, my mother, pop pop, and my grandmother all within seven years time. I am weary. However now my focus has changed from caring for the dying (though my father is nearing the end stages of COPD) to caring for the living in the birth of my first grandbaby last year and now her sister due in March. While there are dark days ahead, it feels really good to stand in the sunshine covered In a different type of spitup and listening to giggles. Though it’s still somewhat lonesome at times. I remind myself that I’m from a long line of strong women who may have passed, but they’re still with me and I’m still one of them. Thank you for being a part of my life when I needed someone stronger than myself to be the voice of reason. Forever grateful for your gift. Christy
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BK Books replied:
Hi Christy, you just reminded us of the circle of life, and all the opposites that go with us. My heart smiles that I have been a support and guide for you. I’ll add you to my “what was good about today” when I go to sleep tonight. Blessings to you and those grandbabies. Barbara
I feel like we should already know each other well. You have helped me through the passing of my great grandmother, my niece, my mother, pop pop, and my grandmother all within seven years time. I am weary. However now my focus has changed from caring for the dying (though my father is nearing the end stages of COPD) to caring for the living in the birth of my first grandbaby last year and now her sister due in March. While there are dark days ahead, it feels really good to stand in the sunshine covered In a different type of spitup and listening to giggles. Though it’s still somewhat lonesome at times. I remind myself that I’m from a long line of strong women who may have passed, but they’re still with me and I’m still one of them. Thank you for being a part of my life when I needed someone stronger than myself to be the voice of reason. Forever grateful for your gift. Christy
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BK Books replied:
Hi Christy, you just reminded us of the circle of life, and all the opposites that go with us. My heart smiles that I have been a support and guide for you. I’ll add you to my “what was good about today” when I go to sleep tonight. Blessings to you and those grandbabies. Barbara
Anne Daigle
If an elderly (say one over 80) person is sick and crashes, hopefully he (or she) has discussed matter with family they know how to proceed.. More of a problem is the healthy appearing 60-80 year old who has not discussed code status with his family. The outcome of CPR may not be one that the individual (or family) is happy with.
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BK Books replied:
Anne, you are so right. That is why healthy or unhealthy we all need to have advanced directives—from the age of 18 on. We never know when life may put us in a life threatening situation. Thank you and blessings! Barbara
If an elderly (say one over 80) person is sick and crashes, hopefully he (or she) has discussed matter with family they know how to proceed.. More of a problem is the healthy appearing 60-80 year old who has not discussed code status with his family. The outcome of CPR may not be one that the individual (or family) is happy with.
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BK Books replied:
Anne, you are so right. That is why healthy or unhealthy we all need to have advanced directives—from the age of 18 on. We never know when life may put us in a life threatening situation. Thank you and blessings! Barbara
Patricia Edwards
I found both the information you gave here and the information I gathered from Suzanne B Obrian on V S E D and MA I D very useful for they were both experiences I went through while caring for my Husband in 2016 and my Mom in 2019 before their passing If it were not for God’s intercession and presence I don’t know if I would have completed these missions with people so close to my heart. Thanks for your understanding and knowledge of what I went through with them.
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BK Books replied:
Blessing to you, Patricia.
I found both the information you gave here and the information I gathered from Suzanne B Obrian on V S E D and MA I D very useful for they were both experiences I went through while caring for my Husband in 2016 and my Mom in 2019 before their passing If it were not for God’s intercession and presence I don’t know if I would have completed these missions with people so close to my heart. Thanks for your understanding and knowledge of what I went through with them.
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BK Books replied:
Blessing to you, Patricia.
Shane
A great to the point no messing around explanation of full code or no code. Very helpful
Thank you
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BK Books replied:
Thank you, Shane.
A great to the point no messing around explanation of full code or no code. Very helpful
Thank you
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BK Books replied:
Thank you, Shane.
Mary Quinn
Years ago at an Indian Health Service Conference on Palliative Care Robert Twycross encouraged use to rethink the terms we use regarding resusitation at end of life. He suggested the term AND-Allow Natural Death.
Unfortunately this hasn’t caught on in general usage. For me it does become part of the talk with patients and families. Rather than talk about withholding treatment, I talk to the families about the possible outcomes of resuscitation at this point in their lives and the option of being kept comfortable as they go through this natural and inevitable stage of their life.
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BK Books replied:
Hi Mary, I forgot to add AND to the list of terms. Most people are familiar with the term “No Code” so that can be a starting point in a discussion. Blessings to you in the work you are doing. Barbara
Years ago at an Indian Health Service Conference on Palliative Care Robert Twycross encouraged use to rethink the terms we use regarding resusitation at end of life. He suggested the term AND-Allow Natural Death.
Unfortunately this hasn’t caught on in general usage. For me it does become part of the talk with patients and families. Rather than talk about withholding treatment, I talk to the families about the possible outcomes of resuscitation at this point in their lives and the option of being kept comfortable as they go through this natural and inevitable stage of their life.
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BK Books replied:
Hi Mary, I forgot to add AND to the list of terms. Most people are familiar with the term “No Code” so that can be a starting point in a discussion. Blessings to you in the work you are doing. Barbara
Jessie H.
Thank you for sharing. This ties in well with the IG post and comments about post-code trauma. Thank you for normalizing death and EOL choices for your audience.
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BK Books replied:
Hi Jessie, thanks for the kind words. Blessings! Barbara
Thank you for sharing. This ties in well with the IG post and comments about post-code trauma. Thank you for normalizing death and EOL choices for your audience.
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BK Books replied:
Hi Jessie, thanks for the kind words. Blessings! Barbara
Patricia
Always enjoy reading your posts,I cared for my deceased husband while reading many of your pamphlets!
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BK Books replied:
Patricia, I am honored that my materials and words have been of help to you during the caregiving time with your husband. Blessings to you. Barbara
Always enjoy reading your posts,I cared for my deceased husband while reading many of your pamphlets!
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BK Books replied:
Patricia, I am honored that my materials and words have been of help to you during the caregiving time with your husband. Blessings to you. Barbara
natalie levinson
Excellent articles—all.
Husband was in hospice in a hospital.
So very thankful for their care..6 years ago.
Natalie 90 yrs independent still and enjoying it!
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BK Books replied:
Hi Natalia, “90 years, independent still and enjoying it”, good for you. Blessings to you. Barbara
Excellent articles—all.
Husband was in hospice in a hospital.
So very thankful for their care..6 years ago.
Natalie 90 yrs independent still and enjoying it!
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BK Books replied:
Hi Natalia, “90 years, independent still and enjoying it”, good for you. Blessings to you. Barbara
Anita
Very well said. I learned more about this when my husbands Aunt had a DNR and was living at an Assisted Living facility. They found her on the floor and called 911. Their duty is to try to save her. The facility did not tell them she had a DNR. But anyway they got to the hospital and they called her sister, her medical advisor, and she was not angry with the rescue people. She went to visit her fallen sister at the hospital and then asked to remove life saving devices. She was well into her 80’s.
Then just a few years ago, we had found this sister on the floor of her house and 911 was called. I don’t think she had a DNR, so all medical procedures went accordingly. However in the state she was in, we knew it wouldn’t be long, so choose to remove devices and was planning to move her to a hospice facility the next day, but she passed in the night.
Another instance, in 2007 my dad, had gone into the hospital and had a surgery to help the peritinitis of the intestine. I did not know much then, but he and I looked at each other and we both nodded it’s okay. I gave him my approval. That night he had to have a breathing tube put in. He did not have a DNR, so the hospital was going to do everything possible. After the family met the next day we decided to cease all devices and he passed within a minute.
These are tough choices, but families also have to take in consideration if they wake up and get a little better what kind of care will they need and what kind of quality life will it be for them.
I have learned so much since my Dad has passed away and am not afraid to talk about death. I have learned much from your blogs as well. Keep it up. God Bless.
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BK Books replied:
Hi Anita, Your life situation with your aunt and father reflect what so many people today are faced with. Thank you for sharing. Blessings! Barbara
Very well said. I learned more about this when my husbands Aunt had a DNR and was living at an Assisted Living facility. They found her on the floor and called 911. Their duty is to try to save her. The facility did not tell them she had a DNR. But anyway they got to the hospital and they called her sister, her medical advisor, and she was not angry with the rescue people. She went to visit her fallen sister at the hospital and then asked to remove life saving devices. She was well into her 80’s.
Then just a few years ago, we had found this sister on the floor of her house and 911 was called. I don’t think she had a DNR, so all medical procedures went accordingly. However in the state she was in, we knew it wouldn’t be long, so choose to remove devices and was planning to move her to a hospice facility the next day, but she passed in the night.
Another instance, in 2007 my dad, had gone into the hospital and had a surgery to help the peritinitis of the intestine. I did not know much then, but he and I looked at each other and we both nodded it’s okay. I gave him my approval. That night he had to have a breathing tube put in. He did not have a DNR, so the hospital was going to do everything possible. After the family met the next day we decided to cease all devices and he passed within a minute.
These are tough choices, but families also have to take in consideration if they wake up and get a little better what kind of care will they need and what kind of quality life will it be for them.
I have learned so much since my Dad has passed away and am not afraid to talk about death. I have learned much from your blogs as well. Keep it up. God Bless.
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BK Books replied:
Hi Anita, Your life situation with your aunt and father reflect what so many people today are faced with. Thank you for sharing. Blessings! Barbara
Lolita Silicani
Thank you for the great reminder. And a hard decision to make at times, for sure.
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BK Books replied:
Hi Lolita, thank you for your comments. Blessings! Barbara
Thank you for the great reminder. And a hard decision to make at times, for sure.
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BK Books replied:
Hi Lolita, thank you for your comments. Blessings! Barbara