During a 'slow code,' the members of the healthcare team are purposely not putting forth their full efforts to resuscitate the patient by moving with no apparent sense of urgency while performing CPR. Do situations arise where a slow code would ever be justified?
NursesSafetyArticle
I have been a nurse for only seven years; however, certain events and situations will remain embedded in my memory for the rest of my life. One of these events took place during my first year of nursing practice when I was employed at a long term care facility.
A 'code blue' was announced through the overhead paging system, along with the room number. Since the facility had no designated 'code team,' any healthcare employees who were located nearby were expected to respond. I dutifully ran to the room and entered a scene that was filled with disorder.
An elderly male patient was lying on the floor adjacent to his bed in a supine position. His body was cyanotic, but still warm. His nurse states that she had been chatting with him less than 30 minutes ago. No rise and fall of his chest was noted. All pulses were absent. This clinically dead man was a full code, yet the multiple people in the room were moving with a disturbingly unhurried pace. I immediately started chest compressions.
A nurse with more than 20 years of experience glanced at me with a smile and sternly said, "Give it up! Don't waste your energy! Wait until EMS gets here, then act as if you're doing something in front of them!" She ended her statement with a quiet giggle as the house supervisor stood over me, grinned, and nodded in agreement.
I continued pounding on the man's chest and could feel his osteoporotic ribs cracking with each compression. EMS personnel and the city fire-rescue squad arrived less than ten minutes later to take over the resuscitation efforts. Approximately 30 seconds before EMS staff entered the room, my coworkers began putting on the show and pretended to exert an all-out effort to save the patient (a.k.a. the 'show code' or 'Hollywood code'). Since EMS has their own documentation, I suppose my peers wanted to appear busy to avoid potential liability later on down the line.
Do situations arise where a slow code would ever be justified? Are slow codes ethical?
A 'slow code' is defined as a cardiopulmonary resuscitative (CPR) attempt by the healthcare team that is deliberately carried out in too slow of a manner for any viable chance of resuscitation. In other words, the members of the code team are purposely not putting forth their full effort to revive the patient. Some anonymous physicians and hospitalists have offered several explanations for conducting slow codes:
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Three justifications for designating a "slow code" (one or more might be cited by different house officers to explain a decision about a particular case):
(a) The patient was being kept alive by technology alone and should, as a moral decision, be allowed to die;
(b) The patient had a chronic disease, which the residents found uninteresting, and from which they felt they could learn little;
SOURCE: Cassell, J. (n.d.). Handbook on Ethical Issues in Anthropology. Chapter 23: Slow Code. American Anthropological Association. Retrieved December 5, 2012, from Case 23: Slow Code - Learn and Teach
Although I am a firm believer in end-of-life options such as hospice and palliative care for patients with terminal prognoses, I also feel that no ethical justification exists for slow codes because they infringe upon the patients' rights to have input in their treatment plan. The slow code also serves to breach the trust that patients and families have in the healthcare team to provide swift resuscitative efforts with a sense of urgency. In summary, if the patient has decided he wants everything done, we should fulfill his request.
