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Resident PGY 1
Henry Ford Hospital
The introduction of cardiopulmonary resuscitation (CPR) in the 1960’s led the American Medical Association to recommend code status – indicating the preference for CPR – for each patient. Currently, all hospitals across the country review code status with patients at admission. A ‘do not attempt resuscitation’ (DNAR) code status means that a patient with decision making capacity has indicated that in the event of a cardiopulmonary arrest, they do not want to receive chest compressions, assisted ventilation or defibrillation. We present the case of a 57-year-old female with a history of bipolar disorder, admitted to our inpatient psychiatric hospital (Henry Ford Kingswood Hospital) for worsening depression, suicidal ideation and a plan to slit her wrists. On admission, she denied suicidal ideation. However, given her extensive psychiatric history including two previous suicide attempts, impulsivity and various non-modifiable risk factors, she was considered at high risk for suicide. In addition, she had multiple co-morbidities including diabetes, previous myocardial infarction (MI), and coronary artery disease with stenting. The patient requested to be DNAR. She articulated the risks/benefits, appreciated the consequences and gave the reasons for her decision. Through this case discussion and review of literature, we present the ethical dilemma of patients requesting DNAR code status while admitted to an inpatient psychiatric unit, after a recent suicide attempt and/or ideations with plan. Providers are required to respect patients’ autonomy, however, also act in patients’ best interests. To what extent should providers respect patient’s autonomy of DNAR code status if there is suspected secondary motive, such as intent to die by suicide or if their decision is impacted by an untreated psychiatric condition, like depression?
Wong, Andrew and Thiem, Rachel, "Decoding Code Status: The Case of DNAR" (2019). Case Reports. 87.