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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.
Zapata JA, Widera E. Partial Codes—A Symptom of a Larger Problem. JAMA Intern Med. 2016;176(8):1058-1059. doi:10.1001/jamainternmed.2016.2540