Slow Codes

Nurses General Nursing

Published

Just wondered what kind of response I might get from this title.

Yes---I was a part of several on the night shift. They usually involved 80+ year old people with terminal illnesses who had idiot families that wanted them coded aka tortured before they went to Jesus.

Specializes in Med Surg, Hospice.

When my dad died (complications from meningitis), the Neurology team took Mom and I into a conference room and explained everything. Unfortunately, at that time, my Mom was having trouble processing what was being said. We had agreed earlier (Me, Mom, and my brothers) that since Dad was essentially brain dead with no quality of life left, than we would let him go.

The head neurologist was a total a**hole about the whole thing. He essentially wanted Dad kept alive so he could do "research", and he confused Mom so bad between the DNR and the termination of life support orders. Since Mom didn't understand what he was saying and he was being such a jerk, I looked him straight in the eye and told him we wanted the life support terminated. He looked at Mom and barked at her "Is this what you want, Mrs. ________?" Mom looked at me, and I said very quietly, there's a difference between a DNR and a termination of life support. Which do you want to do?" Of course, she was put on the spot with this, but she eventually did say she wanted to terminate the life support. I found out after the funeral that he had told a friend a few years earlier that if he was ever in this situation, he hoped that we would "have enough sense to pull the plug". We did follow his last wish, but I really wish I could have ripped the head neurologist a new one.

Had things not gone down like they had, I wouldn't have objected to a slow code at all.

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Specializes in ER/Trauma.
so as a nurse and family member, have these discussions with your families, clear the air and get your health care directives updated and current !
Easier said than done! My parents just don't want to have this discussion at all! :uhoh3:
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Specializes in cardiac med-surg.
Easier said than done! My parents just don't want to have this discussion at all! :uhoh3:

we discuss it every easter, tg, xmas, etc :balloons:

on the job hazard, i guess

how about a really nice hallmark card roy !?

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Specializes in FNP, Peds, Epilepsy, Mgt., Occ. Ed.

I think "slow codes" and "chemical codes" were much more common 20+ years ago than they are now. i remember most of these being written as "just in case" measures until the physician could get agreement on a DNR.

The medicolegal environment was way different then than it is now.

My parents are like Roy's and won't discuss it either. Since I'm the only medically oriented person in the family and live far away I hope those decisions are made before I get there.

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Specializes in ER/Trauma.
how about a really nice hallmark card roy !?

My parents are like Roy's and won't discuss it either. Since I'm the only medically oriented person in the family and live far away I hope those decisions are made before I get there.

My parents are from another country.

My real beef is that they WON'T discuss it. I mean, I'm not bothered about the "legal" implications in as much as I'm concerned about "what do they want and do they understand what resuscitation means and entails".

It's very frustrating that they don't want to discuss this with me, my brother or even amongst themselves!

I've been trying to tell them that "I don't care if the law allows us to pull the plug or not. I just want all of us to be aware of each others wishes so that when a crisis comes about we are not hurting each other in trying to figure out what to do..."

For some reason, they just don't seem to grasp this :(

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I for one remain chronically amazed that civilization (and I use that term loosely) have not come to terms with the idea that we are all living to die. Death is as much a part of life as birth and living yet we just can't seem to wrap our minds around it and embrace it. My mother-in-law finally passed recently. She refused to sign a DNR and left the decision making to be left up to the kids, which were a 3 to 2 vote. The 2 that wanted mom to have a full code, were not as educated as the other 3 and also were the ones that did not want to do any of the daily home maintenance work to help take care of her. The whole thing was a mess. Mom accidently died late one night. I'm pretty sure she was a "slow code", thank God!!

The slow code may be unethical and or illegal, but because we do not have laws in place that require all patients to make a clear decision in writing, the slow code helped everyone make the best decision. The end result would have still been the same, keeping her alive would not have solved her health issues, it would have just prolonged the situation.

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It's very frustrating that they don't want to discuss this with me, my brother or even amongst themselves!

I've been trying to tell them that "I don't care if the law allows us to pull the plug or not. I just want all of us to be aware of each others wishes so that when a crisis comes about we are not hurting each other in trying to figure out what to do..."

For some reason, they just don't seem to grasp this :(

I understand where your parents are coming from, because I went through this with my parents. They won't discuss it because in their minds, if they don't talk about it, it will never be an issue.

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Specializes in ED, ICU, PSYCH, PP, CEN.

I will never initiate or participate in a slow code, regardless of my feelings for whether the patient should be a DNR or not. When I take it upon myself to decide who lives and who dies I hope I have the good sense to get out of the field.

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Specializes in Med/Surg, Geri, Ortho, Telemetry, Psych.

It's illegal and I'd never admit to it IF I did it. Not our call. Even if we think the family is wrong, it's just not up to us. Sometimes I wish it was, but it just isn't.:nono:

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It's interesting how everyone in this country (including most health care professionals) see a full-code as a God given RIGHT that patients/families have. I realize that in a legal sense it can be. But in an ethical sense I'm not sure that I agree with that.

As health professionals, I wonder if we should ever just sit families down and tell them that their family member is terminally ill and if their heart were to stop there would be nothing more we could do for them. Is it really ethical to force families to make a DNR decision in those cases? They're hearing "Do we save your loved one's life or do we stand there and do nothing?"

It's just expected that families should have the full option of us doing EVERYTHING known to medicine on someone who is ready to pass on. I wonder if that's really the healthiest way of looking at life and death issues. Everyone keeps saying it's the families' decision and I see their point in a sense, but in another sense, does giving them unlimited financial and life and death power in a medical setting really make ethical sense either? Maybe medical resources are limited and peoples' lives are also limited and we should accept that a little more readily within our culture in order to do the greatest good for the highest number of people.

I, personally, hope for a dignified, peaceful death when my time comes. That is becoming more of a rarity. A lot of the deaths I see are very drawn out and very frustrating and scary for everyone involved. I just don't agree that we're alway doing the families big favors by putting them on the spot to make impossible decisions. We give so many people false hope and, in the end, guilt and self-doubting about their loved one's death.

I guess, in short, I'm trying to say that I think the entire system has giant ethical flaws. So, to say that you must follow The System correctly in order to be ethically correct doesn't make sense to me.

With that said, I work in an ICU and when someone codes we always do a real code. To cover our asses, you know.

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Everyone keeps saying it's the families' decision and I see their point in a sense, but in another sense, does giving them unlimited financial and life and death power in a medical setting really make ethical sense either? Maybe medical resources are limited and peoples' lives are also limited and we should accept that a little more readily within our culture in order to do the greatest good for the highest number of people.

I, personally, hope for a dignified, peaceful death when my time comes. That is becoming more of a rarity. A lot of the deaths I see are very drawn out and very frustrating and scary for everyone involved. I just don't agree that we're alway doing the families big favors by putting them on the spot to make impossible decisions. We give so many people false hope and, in the end, guilt and self-doubting about their loved one's deaths.

Extremely well said!

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I'm very grateful for the medical director of the SNF in which I work. He leaves our old ones alone. When there is nothing to be done but relieve pain he doesn't send them for tests, doesn't ship 'em to the hospital, he leaves them with us, in their home, and we can let them die peacefully, in their own beds.

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