Expert Health Articles

Advanced Directives and Code Status

Niki SidleNiki Sidle, Bereavement Coordinator

Bridge Bereavement Services

We are faced with decisions every day. Would you like coffee or tea? Soup or salad? On a good day, these may be easy decisions to make. But, if you were asked to make a decision regarding your health care this would be cause for contemplation. One reason that individuals face difficulty is that there is little conversation or education within the community regarding the various types of “wills” or “code status” that medical professionals speak about. Here are a few of the most commonly discussed and what they include:

Living Will: This document contains your written wishes for medical care, such as life-sustaining treatment and includes artificial/technologically supplied nutrition. The living will is only enacted when someone has a terminal condition or is in a permanently unconscious state, determined by two physicians.  

Health Care Power Of Attorney: The purpose of this form is for an individual to be named your advocate in the event you are unable to make your own decision, even temporarily such as in an accident. This person should know how you feel about life-sustaining treatment and other important issues, such as artificial nutrition. This person does not manage anything related to your finances. First and second alternates may also be identified, in the event that the primary cannot be immediately reached.

Legal Will: This is the most commonly known form of “will” that people speak of. A legal will or testament is what an individual uses to name an executor of their estate and the distribution of property. You may write your own will and have it witnessed or notarized, but legal assistance is recommended.

Do Not Resuscitate/DNR: This is a sensitive topic for many individuals and often the last to be discussed, partially due to lack of understanding. Unlike the other documents, this is a physician’s order that is written after discussion with your physician and/or medical team. The DNR form is revocable, meaning that you may change your mind and request resuscitation at any time by speaking with your physician and having a new order written. While most people understand the form as “DNR or Full Code”, decisions regarding the level of intervention is required.

Do Not Resuscitate/Comfort Care: This option is typically enacted when there is a life-limiting illness and comfort care has been chosen, to the point where no aggressive (or life-prolonging) medical intervention is desired, but an individual can elect to have a DNRCC signed at any time. Medical professionals will do everything within their ability to maintain comfort by use of oxygen and pain medication. Referrals to hospice may be made.

Do Not Resuscitate/Comfort Care-Arrest: All measures will be taken to prevent death, including intensive treatments and/or therapies, until the point of cardiac or respiratory arrest. These interventions may include artificial nutrition (feeding tube), insertion of a breathing tube (intubation) or surgical interventions. Essentially, this option means that all medical care will be provided up to the point that the heart stops or one stops breathing, without doing CPR.

Full Code: Until one of the previous have been enacted, an individual will remain full code status and all medical measures will be taken to maintain and resuscitate life. CPR will be performed, defibrillation and intensive cardiac monitoring/treatment will be provided, nutritional and respiratory support will be placed and any surgical intervention will be completed unless otherwise indicated or declined. All individuals will be treated as full code by emergency responders unless it is noted otherwise by the person or family members.