Recently we came across a very interesting opinion piece on StatNews.com. The article discussed the ethics of the “slow code,” which is essentially a halfhearted attempt at CPR in almost assuredly futile situations to save the patient some dignity and pain in their final moments.
See, despite how CPR is sometimes displayed on television or movies, it can be a rather brutal maneuver for the patient, and that doesn’t even factor in the psychological burden it inflicts on the physician performing the act. CPR oftentimes results in broken ribs, brain damage, more pain and it may end up prolonging discomfort for a few more days instead of providing the patient with a less painful and more dignified exit from this world. With a slow code, the doctors may walk instead of running to the patient’s room, do chest compressions much lighter than normal, and give up a little sooner. As you may imagine, there is a major ethical debate with the slow code, and that was the focus of the opinion piece.
Primum Non Nocere
On the surface, it may seem like a doctor has taken an oath to do everything they can to prevent the loss of life, which would mean always performing CPR to the fullest extent possible. And in a world where families can get very emotional about these end-of-life scenarios and where politicians guide medical decisions despite never having to make a life or death decision in the operating room, many doctors feel compelled to perform standard CPR to all patients, no matter their individual situation.
But many doctors see it differently. In fact, a recent survey found that nearly half of all surveyed physicians believed that slow codes were ethical in some situations. Nurses reported similar views. These are the people who routinely see frail, elderly and terminal patients have their pain increased and prolonged as they endure brutal lifesaving efforts to potentially keep them alive a few more days. They are the ones left with the emotional and mental scars after having to perform a fruitless venture on a dying patient only to end up causing the patient more pain in their final moments. Shouldn’t their opinion on the matter carry more water?
But instead of opening up and having these hard conversations about end-of-life scenarios, we stymie these discussions and fail to progress as a society. Sometimes hard decisions need to be made. Sometimes families need to have conversations they don’t want to hear. We should be embracing the ethics debate and giving more power to those who are in the room and tasked with the unenviable role of performing CPR on a dying patient. Until we’re willing to have these hard conversations about end-of-life scenarios and the ethics of a slow code, how can we expect the situation to improve?
To a physician, it’s not always about saving a life. We take a Hippocratic oath, and buried in that oath is a phrase many physicians resonate with – Primum Non Nocere – which translates to “first, do no harm.” If we truly believe those words, then we need to recognize that a slow code – or at a minimum, the conversation about it – has a moral and ethical place in our society.