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Invited Commentary
Less Is More
August 2016

Partial Codes—A Symptom of a Larger Problem

Author Affiliations
  • 1Department of Internal Medicine, University of California, San Francisco, San Francisco
  • 2Division of Hospital Medicine, San Francisco VA Medical Center, San Francisco, California
  • 3Palliative Care and Hospice Service, San Francisco VA Medical Center, San Francisco, California
  • 4Division of Geriatrics, University of California, San Francisco, San Francisco
JAMA Intern Med. 2016;176(8):1058-1059. doi:10.1001/jamainternmed.2016.2540

In this issue of JAMA Internal Medicine, Rousseau1 describes the case of an elderly man with metastatic cancer who underwent a so-called partial code in which clinicians could do “everything but intubation” during an attempt at cardiopulmonary resuscitation. He further describes the efficacy of these partial codes and suggests that code status should never involve a litany of options such as “everything but intubation” or “everything but defibrillation.” Instead, he argues that code status decisions should be a simple dichotomy between all efforts at resuscitation or none at all. While a policy change that does not allow for partial codes seems reasonable, it does not address the greater issue of failure in communication between physicians and patients that frequently sets the stage for these adverse outcomes. Partial codes, by their very nature, represent a lack of shared decision-making that is too frequently seen in discussions with patients with severe illness.

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