"Code status" are the words used by hospital staff to describe the procedures that can be performed on a patient if the heart stops or the lungs fail. When sick patients come into hospital, they (or someone in the family) may be asked:
- If your heart stops, do you want us to use Cardiopulmonary Resuscitation (CPR) to try to bring back a normal heart beat?
- If your lungs fail, which of the following do you want?
- To be connected to a breathing machine and have your underlying disease treated, until you improve and can be disconnected from the machine to breathe on your own, or it becomes clear after a few days that your are not likely to improve at which point you would like the ventilator to be taken away and to die comfortably.
- Not to be connected to a breathing machine under any circumstances, even if the doctors think they can treat your underlying condition. In this case, the hospital staff will make you comfortable and let you die without breathlessness or suffering.
There are many decisions that a very sick patient may have to face. But it is best if you decide about these two problems, complete heart failure and complete lung failure, before you become very sick. Also, it helps if you tell your wishes to your loved ones and write and sign a "living will" (see discussion on Living Wills in the section on Making Decisions About the End of Life). It is also helpful if you talk about these problems with your doctor who can answer questions and note your wishes. Finally, no decision is absolutely final, and you can always change your mind about your code status at any time.
Many hospitals also give patients a choice about whether to receive other treatments, such as feedings, fluids, antibiotics, electrical shock to the chest in case the heart goes too fast, ICU care, pacemakers and invasive procedures. These can be discussed at the same time that you consider requesting not to have CPR or they can be discussed and withdrawn one-at-a-time if treatments are not working well.