The ethics of calling codes

J Med Ethics. 2014 Sep 23. pii: medethics-2013-101949. doi: 10.1136/medethics-2013-101949. [Epub ahead of print]

How long is long enough, and have we done everything we should?-Ethics of calling codes.

Ranola PA1, Merchant RM2, Perman SM3, Khan AM4, Gaieski D2, Caplan AL5, Kirkpatrick JN6.

Author information

• 1Medical Humanities & Bioethics, Northwestern University Feinberg School of Medicine, Chicago, USA.
• 2Department of Emergency of Medicine, University of Pennsylvania, Philadelphia, USA.
• 3Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, USA.
• 4Cardiology Division, University of Pennsylvania, Philadelphia, USA.
• 5Division of Medical Ethics, New York Univerity Langone Medical Center, New York, USA.
• 6Cardiovascular Medicine Division, Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, USA.

Abstract

'Calling' a code can be an ambiguous undertaking. Despite guidelines and the medical literature outlining when it is acceptable to stop resuscitation, code cessation and deciding what not to do during a code, in practice, is an art form. Familiarity with classic evidence suggesting most codes are unsuccessful may influence decisions about when to terminate resuscitative efforts, in effect enacting self-fulfilling prophesies. Code interventions and duration may be influenced by patient demographics, gender or a concern about the stewardship of scarce resources. Yet, recent evidence links longer code duration with improved outcomes, and advances in resuscitation techniques complicate attempts to standardise both resuscitation length and the application of advanced interventions. In this context of increasing clinical and moral uncertainty, discussions between patients, families and medical providers about resuscitation plans take on an increased degree of importance. For some patients, a 'bespoke' resuscitation plan may be in order.