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:
- They sometimes continue discussions and try to convince the patient or family to agree to a DNR order
- They sometimes accede to the family wishes and do the CPR, even though they find it reprehensible to do so
- 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.
- 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.”