Is a slow code ethical?

Published

  1. Is a slow code ethical?

    • 14
      Yes.
    • 23
      No.
    • 27
      Depends on the Patient.

64 members have participated

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.

nurseprnRN, BSN, RN

2 Articles; 5,114 Posts

The reason it's not as bad as you think is because situations are rarely as black and white as you think. Example: A person whose condition is such that recovery is impossible (yes, Virginia, there are such people) and whose treating team has been unable to convince the next of kin that further torture, umm, care is futile, and that great suffering is occurring as a result. Trust me, that nurse did not make that decision.

Ethics do allow a treating team to withhold futile care. You can look it up. (Morals are not the same as ethics, even though a lot of people use the words interchangeably-- look that up too.)

RNperdiem, RN

4,591 Posts

Has 14 years experience.

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

MunoRN, RN

8,058 Posts

Specializes in Critical Care. Has 10 years experience.

Slow codes are a symptom of poorly addressed code status. Many patients aren't appropriate to be coded, in those cases they should be declared medically futile codes and made a DNR, unfortunately this doesn't happen as often as it should which is where the "slow code" comes from.

If the patient you're referring to has been coded many times then they're clearly not a medically futile code. There are probably some bigger picture issues to address in terms of goals and what medical treatment can provide overall, but codes are apparently effective in this patient.

I think we tend over generalize the effectiveness of codes. In some populations it has zero, literally zero, potential to be effective. In others it's going to be effective the vast majority of the time. Take for instance, a patient who has been excessively beta blocked and has severe bradycardia with long pauses to even asystole at times. They may require compressions and pacing at times which is technically a code, yet the majority of the time they'll survive and be discharged without any issues.

MoopleRN

240 Posts

Grandma is a full code because of family. Grandma weighs 92 lbs and has a cardiac hx (not to mention CA/COPD/dementia etc...). Grandma codes. Staff responds and during CPR cracks Grandma's ribs, puncturing her lung. Grandma gets the works and winds up on ICU where she dies. Was that worth a a timely full code response or is family responsible for not allowing her to be a DNR?

To answer the OP's question, should a slow code ever be ethical......

You're asking for a black/white answer to a gray question. You're also a PCT. I'm glad that things you don't know make you "??????". Ask some doctors about slow codes while you're at it, not just us nurses. Your topic is important and will never be resolved.

drowningdaily

106 Posts

Has 6 years experience.

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

Specializes in Medsurg/ICU, Mental Health, Home Health. Has 17 years experience.

No way is it ethical. Nope.

brownbook

3,413 Posts

Has 38 years experience.

"Above all do no harm" certainly applies here. Ethically health care providers cannot do a "slow code." Also ethically health care providers need to allow death with dignity. Performing ACLS on an elderly, dying, comatose, non-responsive, (but not dead) person is the most "harmful" undignified way for a person to die.

BrandonLPN, LPN

3,358 Posts

Has 5 years experience.

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. It's not like "slow codes" are performed because staff is lazy or something. It's not about making a moral judgement about a patient's/family's decision on code status. It's about a clinical judgement on the feasibility of the code itself.

We don't provide any treatment/medication a pt asks for. Educated decisions are made based on the data on hand. Deciding to slow code a pt when aggressive measures are clearly futile is the prerogative of the healthcare team.

PMFB-RN, RN

5,345 Posts

Specializes in burn ICU, SICU, ER, Trauma Rapid Response. Has 16 years experience.

I think you are asking the wrong question. Is it even ethical to code some poor person just so they can survive long enough to do a slow lingering death in ICU?

Very often I feel like I am hurting my patient and being an evil person for no reason.

umcRN, BSN, RN

867 Posts

Has 4 years experience.

Depends on the patient and if a "slow code" is what's need to "stop doing harm" to the patient then it might be the lesser of two evils. We had a patient on my unit once who was going to die. Slowly each and every organ system was shutting down. This was a baby whose primary issue was cardiac but as a result of that other organs began shutting down, kidneys, intestines, lungs, brain (neuro status was questionable on admission actually) but the family could not accept that their baby was dying. We had multiple other centers consult to see if there was something else they would be doing but none had any suggestions nor would accept the patient to their center. We coded this baby multiple times over three months until the final code. I wouldn't necessarily say it was a "slow" code but when the 4th round of epi did nothing the code was called. And we had discussed over those last few days when we knew we were nearing the end the "if the pt codes today" scenario every morning during rounds. As the RN we were told not to hit the code button, to call the doc and start compressions and that things would unfold slowly. We were all in agreement with this. The moral distress the patient placed on those caring her was far worse for staff than the relief we felt that she was finally no longer suffering. Keeping that baby alive was not ethical in any sense of the word. It's unfortunate that things have to get to that point but I also have never been a parent in that situation so I can't speak for the parents. It's a heart breaking situation any way you look at it.