Show and slow codes: A historical analysis of clinicians' adaptations to ethical overreach.
After briefly reviewing the historical development and ethical regulation of resuscitative technologies, this study probes why clinicians engage in the morally problematic practice of show and slow coding and why hospitals tolerate it? Studies conducted in 1995 and 2020 indicate that conscientious c...
| Published in: | Bioethics Vol. 39; no. 4; pp. 318 - 327 |
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| Format: | Article |
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Wiley-Blackwell
May2025
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| Online Access: | View this record in EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ssf&AN=185679517&site=ehost-live header: @attributes: shortDbName: ssf uiTerm: 185679517 longDbName: Social Sciences Full Text (H.W. Wilson) uiTag: AN controlInfo: bkinfo: jinfo: jid: 02699702 6PJ jtl: Bioethics issn: 02699702 maglogo: Y pubinfo: dt: May2025 vid: 39 iid: 4 pid: 480 pub: Wiley-Blackwell artinfo: ui: 185679517 10.1111/bioe.13367 ppf: 318 ppct: 9 formats: tig: atl: Show and slow codes: A historical analysis of clinicians' adaptations to ethical overreach. aug: au: Baker, Robert affil: Department of Philospophy, Union College, Schenectady New York, , USA su: New York (State) Corporate culture Do-not-resuscitate orders Occupational adaptation Patients' rights Bioethics Informed consent (Medical law) Conscience Do-not-resuscitate orders -- Law & legislation Psychology of physicians Cardiac massage Defibrillators Medical coding Mechanical ventilators Advanced cardiac life support sug: subj: Corporate culture Do-not-resuscitate orders Occupational adaptation Patients' rights Bioethics Informed consent (Medical law) Conscience New York (State) Research and Development in the Physical, Engineering, and Life Sciences (except Biotechnology) Medical equipment and supplies manufacturing Electromedical and Electrotherapeutic Apparatus Manufacturing Do-not-resuscitate orders -- Law & legislation Psychology of physicians Cardiac massage Defibrillators Medical coding Mechanical ventilators Advanced cardiac life support keyword: Advanced Cardiovascular Life Support (ACLS) ethics regulations New York State DNR Law non‐resuscitation (DNR) resuscitation slow code Advanced Cardiovascular Life Support (ACLS) ethics regulations New York State DNR Law non‐resuscitation (DNR) resuscitation slow code ab: After briefly reviewing the historical development and ethical regulation of resuscitative technologies, this study probes why clinicians engage in the morally problematic practice of show and slow coding and why hospitals tolerate it? Studies conducted in 1995 and 2020 indicate that conscientious clinicians engage in these practices to protect their patients from abusive or futile resuscitation. And hospitals' clinical cultures tolerate these practices to protect conscientious clinicians from censure, dismissal, delicensing, or legal prosecution for withholding or withdrawing abusive or futile resuscitative technologies without prior patient or surrogate consent. Show and slow coding evolved in American clinical cultures in the second half of the 20th century when closed‐chest cardiac massage, defibrillators, ventilators, and other resuscitative technologies raised seemingly novel ethical questions. To address these questions, bioethics commissions, healthcare societies, lawmakers, and a Roman Catholic Pope developed ethics standards requiring clinicians to obtain patient or surrogate consent before withholding or withdrawing resuscitative technologies. They thus conferred on patients an implicit right of resuscitation even if it was abusive and/or futile. Conscientious clinicians circumvented this implicit right by show and slow coding to protect patients from abusive resuscitation. Recognizing clinicians' benign intent, hospitals' clinical cultures tolerate show and slow coding as acts of conscience, akin to civil disobedience. Thus, rescinding ethics standards and laws requiring prior patient/surrogate consent for non‐resuscitation or for cessation of resuscitative technologies decisions should end show/slow coding. Such a reform should also recognize clinicians' right of conscientious refusal to perform CPR. pubtype: Academic Journal doctype: Article src: R language: English refInfo: copyright: @attributes: flag: N holdings: @attributes: islocal: N |
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