Friday, October 17, 2014

What do you think about 'slow code?'

Here Dr. Brian Goldman describes a "slow code" or "Hollywood code," when doctors are slow to respond to a "code blue" that signals a patient in cardiac arrest because they believe the intervention is futile. 

"Slow code" is an example of the hospital slang Dr. Goldman, an emergency room doctor and CBC broadcaster, writes about in The Secret Language of Doctors.

I posted this on our Parent Voices at Holland Bloorview Facebook group yesterday and there was a discussion about the ethics of not being upfront with families that a full code won't be performed. 

Doctors are obliged to do a full code unless the patient or next of kin say it's okay not to. Sometimes families insist on full intervention even when doctors recommend against it, which is what causes the dilemma for professionals.

I tweeted this question to Dr. Goldman: 

-- how often is slow code called w kids w complex medical needs/and or developmental ?

He replied: 

no data just anecdotal observations. It happens in that group of patients.

Check out the discussion on Parent Voices and leave a comment here.


I appreciate Dr. Goldman's honest in stating that slow codes do exist among children with complex needs and developmental disability.

Perhaps a culture of slow codes begins with some cases in which doctors have had numerous conversations with parents about the true medical futility of resuscitation, yet parents request that it be performed all the same.

However, acts of deception cause doctors to become deceivers. Their nature changes.

The next case of a "slow code" is perhaps not so statistically futile and the next, less so and so on.

Before they realize it, doctors may become the sole arbiters of "futility" -- which these days is more often a quality of life judgement rather than a judgement about whether an intervention will actually work to save a life. They might not even bother with a conversation with the family because the decision has been made. A culture of slow codes permits "Grey-zone" decision-making to be transformed into black. Besides, doctors have little time to spare and slow codes are likely quite effective. Nobody discovers the truth. The family thanks the doctors, donates to the hospital and then lives with the peace of knowing they "did everything."

But one day, it's bound to happen, that a family such as mine discovers the truth about the events surrounding their child's death.

The revelation of deception is an utter devastation.

The bond of trust between parents and doctor in the management of an ill or fragile child is almost sacred. Parents expect and need truth and honesty when they make the most difficult decisions of their lives.

Losing one's child under an act of deception and lies is an greater tragedy when the child's death and futility of treatment were "by no means certain"(Coroner's declaration) and when the only certainty was the child's disability.

There was a time such a deception might have been deemed an act of omission causing death under criminal law. However, now, at a time when society increasingly equates disability with suffering, the discovery of an inappropriate slow code on a disabled person is deemed to be a mere indiscretion. In fact, many would consider it to be a compassionate form of paternalism.