If we were all rational, I don’t think this would be an issue.
I believe my duty as a physician is to advocate for the patient’s best interest based on the information available. If that includes discussing goals of care, you better believe it’s being brought up.
The onus for out of hospital cardiac arrests and steering the discussion towards goals of care should be broached by the ED physician. And this includes checking if patient has a previously stated goals of care. Otherwise interns end up calling a palliative consult for a patient who has a signed DNR.
Religion is often overlooked while discussing code status and having a rabbi or imam involved has greatly helped with these difficult discussions.