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
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
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
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.
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.
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
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