Thursday, November 8, 2012

Slow Codes, Show Codes, and No-codes in Neonatal Intensive Care

Children’s Mercy Bioethics will have its second in a series of live webinar debates about hot topics in pediatric bioethics, on Thursday, Nov. 29, from 12-1, Central Time:  Slow Codes, Show Codes, and No-codes in Neonatal Intensive Care.

Every NICU or PICU doctor has faced the following situation:  A baby is dying, slowly, of multisystem organ failure.  The family insists that everything be done and will not agree to a DNR order.  The doctors, nurses, chaplains and social workers have tried explaining the situation.  The disagreement has become intractable.


In such situations, doctors usually respond in one of three ways: 

  1. They sometimes continue discussions and try to convince the patient or family to agree to a DNR order
  2. They sometimes accede to the family wishes and do the CPR, even though they find it reprehensible to do so
  3. They sometimes refuse to do CPR, explain this to the patient or family and, if disagreement persists, seek legal sanction to override family’s choices.
CMH Bioethics has brought together two national experts in neonatal bioethics to discuss these situations, and debate whether it is ever appropriate to consider a fourth option - do not write a DNR order, but do not do CPR as vigorously or for as long as usual.
  • William Meadow, MD, PhD, Professor of Pediatrics and Assistant Director of the MacLean Center for Clinical Medical Ethics at The University of Chicago, who argues that, in some situations, there is a fourth possible response – one that allows for less than vigorous resuscitation – a “slow code” – without any explicit authorization from the family.
  • Annie Janvier, MD, PhD, Associate Professor of Pediatrics and Co-director of Pediatric Clinical Ethics at the University of Montreal, who argues that “…all resuscitations need to be taken seriously and performed in a consistent fashion every time…. performances and rituals are best left to priests, ministers and mullahs.”
They will debate and discuss different approaches to these difficult cases.  Director John Lantos, MD, will moderate the debate.  The webinar will be free, but you must register here.  

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