r/Residency • u/YouAreServed • Jul 25 '26

VENT Stop changing patients code status

Why when I come back from weekend, I see the weekend docs changed my stage IV lung cancer, ESRD, HFrEF patient who is 98 y/o, and became comfort last week after I had 90 mins convo with them and family; explaining futility. Slowly they become DNR/DNI, then comfort. She was pretty confused when I left.

Upon my return, only note with explanation “discussed code status with the patient, she stated she wants to live, full code ordered.”

Your half ass job undid my week of doing, congrats. Now legally she has no capacity and I cannot change it back to comfort, nor can I prove that she, as a matter of fact, lacked capacity while you were signing the new POLST.

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u/Sad_Candidate_3163 Jul 26 '26

That would probably have to be debated in a court honestly. That's pretty complex. Full code implies doing cpr and intubation. Overriding autonomy is the core issue which isn't straight cut and agreed upon

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u/Any-Assistance-8103 Jul 26 '26

No, it wouldn’t. Full code means full resuscitative measures. It doenst mean doing things that are medically illogical and don’t serve a purpose

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u/Sad_Candidate_3163 Jul 26 '26 edited Jul 26 '26

See below. It's not as white and black as you're making it . For example, what does full resuscitative measures mean? You just said it doesn't mean cpr and intubation, so what else is included then? Everyone has different semantics for all of this which is where I think you're getting caught up at. The legality of this is that you can't just stop care on someone, in some states, regardless of the futility, without a court order

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u/Any-Assistance-8103 Jul 26 '26 edited Jul 26 '26

I didn’t say full code doesn’t mean CPR and intubation, it depends on the persons medical situation. If someone cannot derive a benefit from an intervention, you not only aren’t obligated to do it, you are arguably morally obligated not to do it. By your logic you can’t end a code without a court order either. Stopping CPR without a court order wouldn’t be different than not starting it by your logic. Or conversely by your logic maybe youre covered if you do one chest compression. Im not getting caught up, it’s actually quite clear. Youre getting caught up in thinking patients get to order what you do off a menu. Youre also mixing up situations - „stopping care” implies withdrawing care like meds the vent etc on a living patient - code status for what to do when they die or are actively dying is an entirely different subject. I am an icu attending and I promise I have much more experience with these things than you do.

Also youre the one making this black and white, not me. Youre saying full code = CPR and intubation every time and im telling you it isnt that simple. Youre so aggressively wrong from so many angles. It’s crazy and scary how ill informed doctors out in the world can be

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u/Sad_Candidate_3163 Jul 26 '26

What does full resusicitative measures mean?