Are "Slow Codes" Ever Ethically Justified?

Abstract: Sometimes families will request, even demand, CPR that the treating team believes will be futile or medically inappropriate and no amount of careful discussion dissuades them. One – highly controversial – approach to such situations is the so-called “slow code,” an insincere, fake, or merely performative attempt at resuscitation. In this panel, made up of three clinical ethicists and a palliative medicine physician, the prevalence and ethical viability of slow codes will be discussed. It will be argued that while slow codes clearly violate a range of ethical principles, not least of which being honesty, they may nonetheless occasionally be the least bad among available choices. The role of the ethicist in these decisions will also be discussed: Should they ever directly support such deception? Always actively oppose? Speaker one will discuss findings from an empirical study on the prevalence of slow codes in current medical practice. Speaker two will argue that while slow codes may be unethical in a vacuum, in the context of judicial and legislative overreach into medicine and medical expertise, they may represent an ethically permissible form of civil disobedience. Speaker three will argue that the physician’s decision to perform a slow code is analogous to common experiments in moral psychology, and that if the results of these experiments are valid, then the slow code is often morally permissible. Speaker four will defend the practice of offering slow codes to patients who are experiencing pressure from family to remain Full CPR.