Against Offering "Faux Codes": An Ethically Problematic Workaround

In another essay in this issue of the Hasting Center Report, an argument is made in favor of offering a "faux code" in the setting of a patient who cannot say no to her family who insists her code status remain "full." Under the proposal, an unwritten agreement is made between the patient and the clinical team to withhold cardiopulmonary resuscitation while maintaining a "full code" status in the medical record. The ethical question in this case involves how best to support and uphold the patient's autonomy while minimizing the distress of the patient's family, and the "faux code" is proposed as an ethically supportable intervention. However, pressing ethical concerns remain. In this essay, we offer three main objections to the provision of a "faux code": the role of deceit and its consequences for public trust, the impact on nurses and trainees, and the framing of autonomy under the faux code proposal.