UHS2002, no offense taken of course and thanks for the response.
You must have misunderstood the intent of my message: Spat presented an ethics question, so I gave an ethics response. No ethical issue is black or white. Unethical practices go on everyday in every profession. They are really ideals to aspire to, not laws to adhere to. So saying that something is unethical or not ethically justifiable is different from saying that something is wrong or illegal.
And of course, I've not been on any code team. However, this doesn't disqualify me from providing the ethical arguments for or against the process and I doubt that many professional bioethicists (Ph.D.s) have been on any code teams either. Having a long-standing interest in ethics from my graduate studies in gerontology, I provided this discussion with the ethical arguments against slow codes: physician/patient trust and personal self-determination (autonomy). In fact, I just did a quick bioethics internet search on the subject and found that the bioethics department at the University of Washington School of Medicine tends to offer the same arguments I did:
It is the policy of the UWMC, Harborview and VA that so-called "slow-codes," in which a half-hearted effort at resuscitation is made, are not ethically justified. These undermine the right patients have to be involved in inpatient clinical decisions, and violates the trust patients have in us to give our full effort. Source: eduserv.hscer.washington.edu/bioethics/topics/dnr.html
Furthermore, I just consulted the text
Principles of Geriatric Medicine and Gerontology (realize that I am a gerontology graduate student, so this is obviously the perspective from which I operate) and it states:
Discussions regarding CPR should focus on whether it serves the patient's goals, and such discussions should be repeated at various stages of health because patient values may change. Partial codes are appropriate only when they reflect the wishes of the patient or surrogate and do not violate rational use of elements within CPR. Slow codes are not ethically justifiable.
So again, I certainly don't feel that this is a black and white issue and I am not discussing right and wrong. I don't know what your background is in ethics, but there is a certain way to present and argue ethical dilemmas using autonomy, beneficence, nonmaleficence, justice, etc. and this is what I did. This is much different from presenting my opinions or feelings on the issue and, in fact, these are generally excluded from ethical discussions.
And lastly, I certainly won't question anyone's real-world experiences or decisions they made because I appreciate that ethics get fuzzy in real-life situations and are difficult to adhere to.
I do hope someone will present an argument of how slow-codes are ethically justifiable (using ethical reasoning, of course). I'm sure one exists, I just couldn't think of one.
Good luck to you!
[This message has been edited by Gregory Gulick (edited April 19, 1999).]