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Are slow codes uniquely deceptive?
Michael B Grosso1, Paola Nicolas2,3
1Northwell Health, Division of Medical Ethics, The Donald and Barbara School of Medicine at Hofstra/Northwell, Hemstead, New York, USA.
Bioethics
|April 2, 2025
Summary
Slow codes, or "sham codes," are resuscitative efforts not aimed at return of spontaneous circulation (ROSC). While ethically impermissible in some scenarios, their morality remains debated in others, highlighting complex end-of-life care ethics.
Area of Science:
- Medical Ethics
- Clinical Practice
- End-of-Life Care
Background:
- "Sham codes" or "slow codes" involve resuscitative efforts performed to appear thorough rather than achieve ROSC.
- These practices have been widely condemned for over 50 years.
- Conflicts arise between physicians wishing to withhold cardiopulmonary resuscitation (CPR) and families desiring it.
Purpose of the Study:
- To examine the ethical permissibility of slow codes.
- To analyze clinician obligations in four conflict scenarios involving CPR decisions.
- To explore alternatives and propose reforms for CPR-related conflicts.
Main Methods:
- Ethical analysis of four distinct clinical scenarios involving CPR.
- Examination of clinician's ethical obligations and prerogatives.
- Comparison of slow codes with alternative end-of-life practices.
Main Results:
- Slow codes are deemed ethically impermissible when quality of life or quantitative futility are primary concerns.
- An agnostic stance is taken on the moral permissibility of slow codes in other scenarios.
- Alternatives like non-initiation of CPR and limited CPR trials involve similar non-lying deception for beneficent reasons.
Conclusions:
- The ethical landscape of slow codes is complex, with permissibility varying by clinical context.
- Alternatives to slow codes share ethical considerations, including deception.
- Reforms are recommended to prevent conflicts and build trust in end-of-life care decisions.
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