Rethinking slow codes

BACKGROUND: The ethics of slow codes has been debated for 5 decades, with most commentators opposing to it. The empirical evidence justifying or opposing the practice is non-existent. MAIN BODY: This paper critically reviews the most common and strongest arguments against slow codes, debunking them, including harm and deception. It then argues that slow codes, when they are done to benefit relatives, may be justified. It articulates conditions and sketches a protocol to be used by healthcare professionals to decide whether a slow code is indeed justified. CONCLUSION: Family-centered care obliges healthcare providers to care for patients as well as for the relatives. Slow codes may be the best way to optimize care for the relatives while respecting a surrogate decision-making process that stems from the principle of respect for persons.