Medical Professionals Performing Deceptive CPR Technique Called 'Slow Code' - Uncovering an Unsettling Practice Among Healthcare Workers
In the world of medicine, the line between helping and hindering can often blur, especially when it comes to end-of-life care. A contentious issue that has been gaining attention is the practice known as "slow codes." This article aims to shed light on this ethical dilemma and the ongoing debate surrounding it.
At its core, medicine is about helping people live as healthily as possible within a finite lifespan, not about forestalling death at all costs. However, in certain circumstances, CPR is required, even when all involved agree that it may not be in the patient's best interests. Requiring CPR in such situations is ethically inappropriate and may be unlawful in some jurisdictions.
Slow codes, a spectrum of practices including a slight delay in response or deliberately ineffective chest compressions during CPR, have been a subject of debate. Proponents argue that slow codes are a pragmatic ethical compromise, balancing compassion, professional responsibility, and truth in situations where doctors lack the freedom to fully withhold CPR. These codes can avoid the harms of aggressive, often futile resuscitation while still respecting family expectations and legal constraints.
However, the persistence of slow codes is partly due to fear among physicians, including fear of litigious families, judicial orders, and the constraints of state law. This fear often compels medical staff to perform CPR without real intent to reverse death, a practice that has been criticized as deceptive.
Hospitals introduced Do Not Resuscitate (DNR) orders as a solution, but the system remains inconsistent and reactive. An alternative approach, informed non-dissent, where families are better informed and consent to withholding aggressive resuscitation, is proposed as more transparent and ethically preferable.
Nearly half of critical care physicians surveyed believe slow codes are ethical in some circumstances. However, hospital policies that mandate CPR by default, without requiring clinicians to assess whether it is medically indicated, are ethically and legally inappropriate.
The debate around slow codes was recently covered in a special issue of the journal Bioethics. While some bioethicists consider slow codes dishonest and unethical, a new wave of scholarship suggests they may be morally defensible.
The solution to the persistence of slow codes lies in systemic reform, including advance care planning, real-time assessment of CPR appropriateness, and empowering clinicians to make decisions based on a patient's best interest, not just fear of liability. This reform would ensure that CPR is used when it is truly beneficial, and not as a reflexive response that defies logic or compassion.
In conclusion, the ethical argument surrounding slow codes in medicine revolves around whether performing intentionally limited, half-hearted CPR on terminally ill or frail patients is morally defensible. While the practice remains controversial, it is clear that systemic change is needed to ensure that CPR is used only when it is truly beneficial and not as a default response.
References:
[1] Lantos, J. D., & Dresser, R. (2007). Slow codes. The Journal of Bioethical Inquiry, 4(2), 87-93.
[5] Brody, B. (2007). Slow codes and the ethics of dying. The New England Journal of Medicine, 357(23), 2379-2381.
- The ongoing debate surrounding 'slow codes' in medicine primarily revolves around the ethical question of whether intentionally limited, half-hearted CPR on terminally ill or frail patients is morally defensible.
- In certain circumstances, proponents of 'slow codes' argue that these are a practical ethical compromise, balancing compassion, professional responsibility, and truth in situations when doctors lack the freedom to fully withhold CPR.
- The persistence of 'slow codes' is partly due to fear among physicians, including fear of litigious families, judicial orders, and the constraints of state law, which often compels medical staff to perform CPR without real intent to reverse death.
- Advance care planning, real-time assessment of CPR appropriateness, and empowering clinicians to make decisions based on a patient's best interest, rather than fear of liability, are proposed as potential solutions to the persistence of 'slow codes'.
