ALLAS, TX—A major principle of medical ethics is that of autonomy, which states that patients should be highly involved in decisions regarding their health care. In an effort to better comply with this essential principle, the American Heart Association (AHA) has recently recommended that, whenever possible, patients should “run their own codes.”
In the past, ethicists believed that simply allowing patients to choose whether they wished to be resuscitated or not (DNR vs Full Code) was enough to satisfy the principle of autonomy. “It’s now crystal clear,” said medical ethicist, Ed Thickle, “that this does not go far enough. The old paternalistic model of doctors shouting out orders for epinephrine, shocks, and more without involving the patient is simply unacceptable today. When someone chooses to be Full Code, that patient, when in cardiac arrest, should be able to fully guide how the code is run.”
In fact, if the code discussion had never yet taken place, the doctor is encouraged to halt CPR to review with the patient the various therapeutic options available in a crash cart. “Cardiac arrest is as good a time as any to have this discussion,” said AHA spokesperson A.C. Ellis, “because otherwise, how would the patient know what medications to order?”
Early results of patient-run codes have been mixed. “Most of the time, we just stand around waiting for guidance, but it never comes,” said ICU nurse, Rhee Sustate. “While leading the code, these patients tend to be silent and frozen in place, and on occasion, they even wet themselves…so, in other words, they’re no different than interns running codes.”
Others complained that these patients have unrealistic expectations about resuscitation attempts even when they are proving futile. “I wish this guy would pronounce himself dead already,” said a nurse named Maya Armertz as she entered her 48th consecutive hour of compressing his chest.
Meanwhile, some patients sought to take advantage of their new power. Nurse Sustate recalled a patient named Connor Tist who called a code on himself, claiming to be in ventricular fibrillation. “I was initially skeptical because, to me, it looked like he was in normal sinus rhythm, and he was awake, alert, and talking. Then, instead of CPR and shocks, he ordered repeated injections of Dilaudid. I’d never heard of opioids having resuscitative effects, but who was I to argue with the person running the code?”
When confronted about it, Mr. Tist snapped, “Um, my VFib really hurts, okay?!”
Overall though, medical ethicists are thrilled that patients are finally having more say during their most vulnerable time. The AHA, meanwhile, has this piece of advice for interns and residents: “Next time a code is called, there’s no need to sprint to the room. The patient’s got you covered.
