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Resuscitate but not Intubate? Partial Codes in Pediatrics.
Andrew Silverman1, Jason Batten2,3, Emily Berkman4,5
1Division of Child Neurology, Department of Neurology.
Pediatrics
|July 12, 2023
Summary
Partial code status in pediatric emergencies poses ethical dilemmas. Discussing parental grief, healthcare team distress, and system-level issues is crucial for effective and ethical end-of-life care decisions.
Area of Science:
- Pediatric Medicine
- Bioethics
- Emergency Medicine
Background:
- Partial code status, particularly "resuscitate but do not intubate" orders, presents complex ethical challenges in pediatric critical care.
- A clinical vignette involving a pulseless infant with limited life expectancy highlights these dilemmas.
Purpose of the Study:
- To explore the ethical considerations surrounding partial code status in pediatric medicine.
- To analyze the perspectives of parental grief, healthcare team moral distress, and systems-level factors.
- To propose recommendations for improving hospital policies regarding code status orders.
Main Methods:
- Ethical analysis of a clinical case vignette.
- Commentaries from multiple perspectives: parental grief, healthcare team ethics, and hospital systems.
- Review of existing hospital code status order designs.
Main Results:
- Partial codes can arise from parental grief, but may lead to moral distress for healthcare providers.
- Relational ethics emphasizes honest communication and pain management in these situations.
- Hospital systems may inadvertently encourage partial codes; changes are needed to discourage them.
Conclusions:
- Healthcare systems should discourage partial codes and ensure clarity in resuscitation orders.
- Addressing parental needs while managing healthcare team moral distress requires careful ethical navigation.
- Improved systems design and communication protocols are essential for ethical end-of-life care in pediatrics.
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