Literature review: decision-making regarding slow resuscitation


Jacinta Kelly
College Lecturer
School of Nursing and Midwifery
Brookfield Health Science Complex
University College Cork
Telephone: +353-21-4901642


Aims and objectives.  Applying ethical principles as a framework, a review of the literature will be presented regarding the decision-making process of slow codes.

Background.  Slow codes are cardiopulmonary resuscitative efforts intentionally conducted too slowly for resuscitation to occur. While some authors argue that a slow code is a non-maleficent and beneficent act towards the hopelessly ill patient, others believe that this practice is harmful and deceptive, that it disregards patient and surrogate autonomy and deprives the patient of a peaceful death.

Method.  Literature review.

Results.  Decision-making surrounding cardiopulmonary resuscitation receives considerable attention in the literature. However, data relating to the decision-making process in slow codes is sparse. One ethnographic study described the practice of slow codes as doing good and preventing harm to the patient.

Conclusions.  It was evident from the literature review that slow codes, even in the most limited form, are invasive and undignified and that they prolong death and suffering. Further research is needed to examine why slow codes happen despite the availability of a do-not-resuscitate order.

Relevance to clinical practice.  Decision-making regarding cardiopulmonary resuscitation is increasingly problematic in Ireland. The literature review suggests that clinical guidelines regarding decision-making and cardiopulmonary resuscitation should be introduced to reduce the likelihood of slow codes occurring, but also that nurses and doctors endeavour to communicate more effectively with patients and family.