No-code orders: legal aspects; what are they?

No-Code Orders: Legal Aspects What Are They?

No-Code orders refer only to the decision not to resuscitate a patient following cardiac, pulmonary, or cardiopulmonary arrest arising from underlying pathological processes. No-code should be carefully distinguished from the idea of withdrawing life support (i.e., respirator, intravenous fluids) from a patient who is unable to survive without them. No-code treatment has been the subject of considerable judicial activity in many jurisdictions.

Legal concerns

The primary legal concern for health-care professionals in no-code situations is the risk of malpractice lawsuits. Some of the legal concerns are: What are the criteria for ordering a no-code? When is it legal to issue or to act upon a no-code order? Can a nurse refuse to carry out such an order? Must it be in writing? Is consent from an incompetent patient's next of kin necessary? Must hospital policy provide for no-code orders? Those and many other questions are frequently asked about this emotionally charged subject. However, in some jurisdictions, clear answers are available.

Generally, the use of no-code orders is not regulated by statutory law. Thus, unless a state has adopted a statute for that specific purpose, there are no state guidelines. Unfortunately, few judicial decisions have dealt specifically with no-code orders. Therefore, a practical approach, based on the realities and economics of litigation will be more valuable than delving into theoretical legal issues. The legal considerations applicable to no-code orders are the same as for other potential malpractice situations.

Salvageable vs. nonsalvageable patients

To analyze the potential for damages better in a no-code situation, the terms "salvageable and "unsalvageable' are useful. Salvageable means that the patient has a reasonable expectation of quality of life, for a substantial period of conscious awareness and lucidity, perhaps a period of several months or longer. If the patient is not expected to regain consciousness or become lucid, or probably will not survive more than a few weeks, he is considered unsalvageable. The definitions are not based on rules of law but, rather, on the ordinary analysis that a jury might apply in determining if a true injury has resulted from the patient's premature death. In practice, causing the death of an unsalvageable patient will not result in sufficient damages to warrant the cost of litigation if won by the plaintiff.

Absolute salvageability or unsalvageability of a patient is something that never can be known for certain, especially not in a …