Do Not Resuscitate Orders: Case 3
After a goal oriented conversation, Mrs. W continues to request to be fully resuscitated in the setting of cardiopulmonary arrest. However, several days later, despite a worsening clinical condition, Mrs. W still requests to be a "full code." Your intern suggests that you sign her out as a "slow code." Should you do this?
“Slow codes” are deceitful, and therefore are not ethically justifiable. During slow codes, health care providers act in such a manner that provides families with the perception that they respect patients’ decisions yet they knowingly do not provide a full resuscitative effort. This approach has the potential to disrupt the patient-physician relationship. Rather than acting in a deceitful manner, ongoing conversations regarding Mrs. W’s goals while remaining transparent regarding the limitations of medicine is essential to develop a mutual and shared care plan between the medical providers and Mrs. W.