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Elder Care News
‘Slow Code’ Token Resuscitation on Hopelessly Ill
Prolongs Suffering
Some say 'slow codes' are going through the motions, being
kinder to desperately ill, usually elderly patients
 Nov. 2, 2007 – Most people, even senior citizens
who are more familiar than most with medical terminology, have never
heard of “slow codes.” This gruesome practice is when the medical staff
goes through the motions of attempting to resuscitate an extremely ill
patient but it is just for show. Resuscitating hopelessly ill patients
too slowly to save their lives can be an invasive and undignified
procedure that prolongs death and suffering, says nursing ethics
lecturer Jacinta Kelly.
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Kelly, from Trinity College Dublin, has called for
clinical and legal guidelines to be issued to prevent the practice of
slow codes and highlighted the need for better communication about do
not resuscitate (DNR) orders. Her plea is published in the November
issue of Journal of Clinical Nursing.
She hopes that this step will help healthcare
professionals who often find themselves in a very difficult and
unenviable position.
“If a DNR (Do Not Resuscitate) order does not
exist, healthcare professionals are expected to attempt resuscitation
even if the patient is terminally ill,” she explains.
“Slow codes are seen as a way of going through the
motions, being kinder to desperately ill patients and avoiding potential
legal action. But it is unfair on the patient and also very difficult
for staff who are keen to see patients end their life in a peaceful and
dignified way.”
Jacinta Kelly’s comments come after she carried out
a review of international research into resuscitation covering more than
40 years. This underlined the changing face of end of life care – with
more people dying in hospital than home – and the difficult legal and
ethical dilemmas that medical advances bring for healthcare staff.
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More Information about Slow Code |
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Noah Adams talks with Dr. Gail Gazelle about the practice of
"Slow Code" in hospitals. Also known as "Show Code," "Hollywood
Code" and "Light Blue," a a Slow Code happens when a
terminally-ill patient goes into cardiopulmonary failure. The
medical staff goes through the motions of attempting
resuscitation but do not make a sincere attempt to revive the
patient.
>>
National Public Radio, All Things Considered, 2/11/1998
>>
The Slow Code — Should Anyone Rush to Its Defense? New
England Journal of Medicine, 2/12/1998
Slow Codes, Show Codes and Death
Aug. 22, 1987 - New York recently became the first state to end
the need for two deadly deceits in hospitals. One is the ''slow
code,'' meaning medical resuscitation teams should move very
slowly. The other is the ''show code,'' meaning resuscitation
efforts should be faked, for the family's sake.
Read more at NY Times |
|
“DNR orders are normally noted on a terminally ill
patient’s chart and, as a result, no attempt is made to resuscitate them
if they suffer a cardiac arrest” she explains. “However, it is clear
from my research that, despite the availability of DNR orders, the grey
area of slow codes -where healthcare professionals resuscitate a patient
too slowly for their efforts to be successful – is still an issue.
“Patients need to give their consent for a DNR
order to be put on their notes, but my review suggests that there are
often reasons why this is not possible and slow codes end up being used.
“For example, the patient can be too ill,
unconscious or not mentally competent to make a decision or the
healthcare professional may be worried or uncomfortable about bringing
up a subject that may distress the patient or their families or deprive
them of hope.
“There are also issues about dealing with
unrealistic expectations when it comes to resuscitation and the strong
religious convictions of some patients and families. competent to make a
decision or the healthcare professional may be worried or uncomfortable
about bringing up a subject that may distress the patient or their
families or deprive them of hope.
“There are also issues about dealing with
unrealistic expectations when it comes to resuscitation and the strong
religious convictions of some patients and families.
“While some researchers argue that it is kinder to
use slow codes when a patient is devastatingly ill, others maintain that
it is harmful and deceptive, disregards the wishes of patients and their
families and deprives patients of a peaceful death.”
Jacinta Kelly says that, at the very least, further
research is needed into why slow codes are still used and how nurses and
doctors decide to carry out token resuscitation attempts.
“Diminishing family support and increased access to
healthcare mean that more people are now dying in hospital than at home
in Ireland” she adds.
“That inevitably leads to an increase in
initiatives that prolong life and ongoing debates about how to provide
terminally ill patients with a peaceful and dignified death.”
Jacinta Kelly’s review found that researchers agree
that all decisions relating to cardiac resuscitation should be made in
accordance with up-to-date clinical guidelines.
“No clinical guidelines exist in Ireland and my
research indicates that national and local guidelines should be devised
to aid decision-making” she says.
“My review also shows that professionals are
sometimes encouraged to instigate slow codes because of their perceived
fear of being sued. This points to the need for legislative clarity in
Ireland, including legally-binding advanced directives -such as living
wills -which already exist in countries like America.
“It also shows that patients and their families
often don’t understand what cardiac resuscitation involves and sensitive
communication skills are needed to explain this emotive area.
“The evidence also suggests that written
information on cardiac resuscitation should be devised, to explain that
a do not resuscitate order only covers that specific procedure and will
not result in other treatments being withheld or the patient receiving
substandard care.“
Editor’s Notes:
• Literature review: decision-making regarding slow
resuscitation. Kelly J. Journal of Clinical Nursing. 16, 1989-1998.
(November 2007)
• Founded in 1992, Journal of Clinical Nursing is a
highly regarded peer reviewed Journal that has a truly international
readership. The Journal embraces experienced clinical nurses, student
nurses and health professionals, who support, inform and investigate
nursing practice. It enlightens, educates, explores, debates and
challenges the foundations of clinical health care knowledge and
practice worldwide. Edited by Professor Roger Watson, it is published 10
times a year by Blackwell Publishing Ltd, part of the international
Blackwell Publishing group. www.blackwellpublishing.com/jcn
• About Wiley-Blackwell. Wiley-Blackwell was formed
in February 2007 as a result of the acquisition of Blackwell Publishing
Ltd. by John Wiley & Sons, Inc., and its merger with Wiley’s Scientific,
Technical, and Medical business. Together, the companies have created a
global publishing business with deep strength in every major academic
and professional field. Wiley-Blackwell publishes approximately 1,400
scholarly peer-reviewed journals and an extensive collection of books
with global appeal. For more information on Wiley-Blackwell, please
visit www.blackwellpublishing.com or
http://interscience.wiley.com
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