AccessMedicine's Case of the Week: Establishing Code Status

From: Resident Readiness: Internal Medicine

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Mr Daniels is an 89-year-old male with a history of COPD, hypertension, and coronary artery disease. He is admitted to the ICU for acute respiratory failure due to exacerbation of his COPD. He requires intubation and mechanical ventilation. The day after admission, his wife presents evidence of a universal DNR order form. After discussing this with the health care team, it is decided to maintain the current treatment plan of intubation and mechanical ventilation. The patient's son, who was previously appointed the patient's health care power of attorney, disagrees with this decision. He would like the patient to be extubated, removed from mechanical ventilation, and allowed to pass away from natural causes. Before a treatment plan decision is ultimately reached, the patient suffers cardiac arrest and is unable to be revived. The patient is pronounced dead by his attending physician.


1. Was the code status clearly determined?

2. Who is allowed to make health care decisions for this patient?

3. Who may pronounce this patient dead?

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Julie Grishaw, ACNP

Senior Editor, McGraw-Hill Education