From code status to core values 

By Jessica Park, MD, Johns Hopkins Medicine 

A routine part of admitting a patient to the hospital involves asking about code status. I ask every patient: “If we were to find you unresponsive in the hospital, would you like us to perform a full resuscitation including CPR that involves pumping on your chest to bring you back to life and a breathing tube insertion so that a machine can breathe for you?” For patients who don’t come to the hospital often, this can be a daunting question.  

I met Mr. R in the ER on a cold winter day. When asked this question, Mr. R paused and gave a long sigh. He was a relatively healthy middle-aged man whose only daily medication was for his well-controlled blood pressure.  

“Doc, can I get back to you after I discuss with my family?” 

The next day I visited Mr. R in his hospital room. “My wife and I talked more about the question you asked yesterday. I want you to do everything you can to bring me back to life, but if I’m in a vegetative state, I don’t want to be connected to machines that will keep me alive. Please let me go when that time comes.”  

I thanked Mr. R for letting me know of his code preference. I then asked if he had completed his advanced directive. He replied no and requested to speak to a social worker to start the process. He didn’t want to wait any longer. Being hospitalized, he realized he could get sicker at any moment, and this grave question could fall on his loved ones to answer. 

Healthcare professionals have a unique opportunity to address advanced care planning, which refers to the process of documenting values and preferences for future medical care. It’s more than just code status. It also involves designating a power of attorney who may speak on one’s behalf if the patient were to lose the ability to make medical decisions. 

My spouse and I recently completed our advanced care planning after having children who now depend on us. It wasn’t an easy discussion but a necessary one. We feel more prepared for any unfortunate circumstances that may befall us. Having experienced advanced care planning firsthand, I now feel even more empowered to initiate this crucial conversation with patients who are hospitalized but not sick enough to need advanced care at this time.  

I encourage fellow healthcare professionals to do the following to make advanced care planning a part of routine care: 

1. Introduce advanced care planning sooner than later.

This could be during an annual clinic visit or upon admission to the hospital. A clinician bringing up advanced care planning can motivate patients to think more about their values and preferences when it comes to medical care.  

2. Ask patients what matters most to them in a situation where they are extremely ill.

3. Check in on patients at follow-up visits.

Be a resource and let them know they are not alone in this process. 

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This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.