I agree. We often have a code status conversation when the patient is unstable or even not able to communicate his or her wishes. I have seen patients with stage 4 cancer being intubated and coded. Talking to the family later, I realized that nobody has had this discussion with the patient/family before and the patient never had a chance to think and talk about it. Physicians often miss an opportunity to talk about the code status in an outpatient setting. The best time to address it when things are relatively stable and the patient has time to think about it. Obviously, talking to a 20 year old with no medical problems about a code status is not appropriate. When treating patients with chronic medical conditions, this should be an essential part of their management. The problem as I see it is that the physicians who manage patients on day to day basis are often not the ones who treat these patients in ICU. Also, patients and their families often have unrealistic expectations from resuscitation and intubation.