Is a slow code ethical?

[blackvans1234]

I assume not, but let me provide detail.

Im a pct at a hospital, this nurse is new to our unit and was talking about how a patient of hers (in the past) did not have a DNR but really should have, he coded multiple times etc.

She made a statement about how they ran a slow code so he could just die.

Is a slow code ever ethical?

Personally I think that this nurse should not have been judging if someone should be a DNR or not. Especially if it is her patient.

[Guest219794]

"Fast or slow code, when the heart stops, it often for good reason. Most of the dead are going to stay dead"

Technically true, but irrelevant. Most dead people do stay dead, but it's nice when the ones that don't stop by to tell you how much they enjoyed grandson's birthday party.

""Above all do no harm" certainly applies here. Ethically health care providers cannot do a "slow code.

"Do no harm" really doesn't apply here. We often harm people. We regularly do to patients what we would never allow on our own families. Often, coding a person does them harm. "slow codes" are an attempt at mitigating this harm.

I think nurses and doctors need to be given the benefit of the doubt to be able to know when a code is feasible and when it's no more than desecrating a dead body

Desecrating a body is the least egregious effect of futile medical care. At least it does not cause suffering. Reviving a person who's life will be dominated by pain and misery is far worse.

To the OP- the real reason for the debate and discussion on this thread is your use of the term "ethical". That term has a certain technical definition in nursing. In general, people use the terms "ethical" and "moral" to define doing what is right, and I suspect that that is the context of your post.

Had you post read "Is it ever in the best interests of a patient to do a slow code?", I suspect the discussion would have been different.

Often, while we are providing futile and harmful "care", we say that we are fulfilling the pt's wishes.

[Pudnluv, ASN, RN]

The definition of insanity......doing the same thing over and over again and expecting a different result. It seems to me that the patient that has coded multiple times is truly trying to die. The universe is clearly trying to tell us something. Running a slow code is not the same as not coding at all. It is allowing the powers that be to do what they were trying to do all along. There is also a big difference in running a slow code on someone who has been coded over and over again and running a slow code on someone who codes for the first time. This is an issue that probably should be taken up with the Ethics Committee at your facility. I don't know if it is the most ethical thing to do, but it certainly is the most humane thing to do.

[PMFB-RN, RN]

This is an issue that probably should be taken up with the Ethics Committee at your facility. I don't know if it is the most ethical thing to do, but it certainly is the most humane thing to do.

*** Sometimes you can't win. The head of the ethics committee (a physician) at my last hospital (Magnet) deleted (from the computer order entry) my first four ethics consults without action or comment. On the 5th she called me and told me that too many ethics consults made the hospital look bad and that I should be more "careful".

[kbrn2002, ADN, RN]

My answer would be a slow code is NEVER ethical, but is often humane and compassionate.

I agree in principle, but have to go with don't do it. The code decision is not ours to make, like it or not we are obligated to follow the pts/families wishes

[PMFB-RN, RN]

I agree in principle, but have to go with don't do it. The code decision is not ours to make, like it or not we are obligated to follow the pts/families wishes

*** I don't see it that way. I will (and have) gone against a family's wishes and refused to code a patient who I knew did not wish to be coded. I am my patient's advocate. If that means I have to advocate for them and their wishes and against their family then I will.

[Blue Roses]

Is a "slow code" generally offered as an option when discussing code status choices with the patient? I say if the patient is educated fully about it and choses to be a "slow code" then it is ethical. If not then no it's not ethical. Why go through the motions? Like what was said before... usually the heart stops for a good reason. If the person is dead it's likely they'll stay dead. And I don't want to be the nurse who's feeling the 92 yr old grandma's ribs crack and snap under my hands as I give compressions. I makes me feel icky in my stomach.

[RNperdiem, RN]

One trend I have seen in my almost 20 years in nursing is the increasing use of palliative care and hospice services for patients who really need it.

Years ago patients who would have been "slow coded" are now DNR.

I find doctors a lot more upfront with families about withdrawing support, DNR and hospice.

I personally have never witnessed a slow code. The rise of the DNR and Rapid Response in hospitals has had an impact.

[PMFB-RN, RN]

One trend I have seen in my almost 20 years in nursing is the increasing use of palliative care and hospice services for patients who really need it.

Years ago patients who would have been "slow coded" are now DNR.

I find doctors a lot more upfront with families about withdrawing support, DNR and hospice.

I personally have never witnessed a slow code. The rise of the DNR and Rapid Response in hospitals has had an impact.

*** Ya your right but some people / organizations haven't got the message.

[TheCommuter, BSN, RN]

Is a "slow code" generally offered as an option when discussing code status choices with the patient?

A slow code is never, ever offered upfront when discussing code status options with the patient or family. It is one of those 'hushed' processes nobody ever admits to because doing so might get you in trouble. People will admit to conducting slow codes with the protective cloak of internet anonymity, but they would be risking their jobs and careers by divulging this information out in the open.

Your profile indicates you're still a student, so let me provide a definition.

A slow code is defined as a resuscitative (CPR) attempt by the healthcare team deliberately carried out in way too slow a manner for any viable chance of resuscitation. The patient, family, or power of attorney is often demanding that the patient be a full code, but the healthcare team is doing something else behind closed doors.

In today's healthcare facilities we either code patients with all-out resuscitative efforts or we make them DNR status (do not resuscitate). The slow code is not an official option, nor will it ever be, because it guarantees the patient's demise.

[leslie :-D]

*** I don't see it that way. I will (and have) gone against a family's wishes and refused to code a patient who I knew did not wish to be coded. I am my patient's advocate. If that means I have to advocate for them and their wishes and against their family then I will.

thanks for this.

i too, have completely disregarded family wishes when i knew the pt's wishes, which were contrary.

more often than not however, i have seen pts defer to what their family wants...

putting their own personal desires aside.

it is at those times that i have been their voice, and have acted accordingly.

One trend I have seen in my almost 20 years in nursing is the increasing use of palliative care and hospice services for patients who really need it.

Years ago patients who would have been "slow coded" are now DNR.

I find doctors a lot more upfront with families about withdrawing support, DNR and hospice.

I personally have never witnessed a slow code. The rise of the DNR and Rapid Response in hospitals has had an impact.

again, working inpt hospice for many years, i've had palliative care pts who remained full codes because of what family wanted.

i have also witnessed head-butting between drs - one who wanted to pursue aggressive (but futile and invasive) tx, vs the other dr who just wanted them to die with dignity.

i'm relieved to read that you have seen an improvement, because at the time, i certainly hadn't.

and "slow codes" have indeed, been the saving grace for a few of my pts.

for that, i and they, are most grateful.

leslie