Guidelines on calling a code to reduce potential harmOne subject that has never been examined as it should is the effect of repeated discussions regarding code status can have on family and patients as well as providers of health care. I certainly believe that these repeated discussions regarding CPR can have a traumatic impact to family members and even a more serious impact on the patient. In addition to these impacts, the discussions can erode trust and make the whole procedure ineffective. The treating team is also highly distracted from interventions and discussions can benefit both the families and patients.

Why we should focus on harm reduction

I believe that thinking more about reducing harm rather thanking talking to families and patients over and over again about CPR is more productive and much more beneficial to all involved. I strongly agree with Soloman, Blinderman and Krakauer who argue that people need to think actively about not providing CPR as an ethical alternative which is the right path for reducing harm in some cases. In UK, this is the kind of approach they follow and I have found that not focusing too much on code discussion is highly refreshing.

Many hospitals today have put in place policies on non beneficial care as a way of helping them deal with families and parents who request for non- beneficial care. Actually, in most of these health care institutions, the health care providers must call the ethics committee first before they invoke the policy. This policy is nevertheless used as a last resort and it is rarely utilized in most cases. It is rather important that the policy is invoked especially in cases where the family is in a trauma and overburdened with making such big decisions that can have far reaching impacts on their loved ones.

Team support, communication and team support

Most families are tremendously overburdened when they have to make a life and death decision on their loved ones. In such situations, it is common to find the families in anxiety, depressed and suffering from post traumatic stress. According to a recently concluded research, families facing such a situation where they need to make an end of life decision in ICU desire to be given more guidance and advice than they actually end up receiving. Evidence exist showing that treating, communication and team support can help in ameliorating most of the distress that results from being stressed by having your loved family member in a critical condition. In fact, most family members are more traumatized when they are the person ‘pulling the plug’. Under such circumstances, it would really help to take off some of the burden from the family members by taking over the responsibility. This can be a great sign of kindness than can have significant benefits to the patient and family.

Any code that is legitimate must follow the ACLS guidelines including short codes. Under the guidelines, the code’s discretion is left at the discretion of code team and attending physician. As such, calling a code where