Ethical Disobedience: Harm, Futility, and the Slow Code

This session will examine the ethical status of slow codes — resuscitation attempts intentionally performed without genuine effort — in cases where CPR is futile or medically inappropriate but where implementing a DNAR order is challenging or conflict-ridden. Clinicians in such situations face a moral trilemma: perform harmful interventions, unilaterally refuse care, or perform a slow code. None of these is particularly ethically attractive. We will survey the longstanding bioethics consensus condemning slow codes and evaluate the arguments for and against that position. We will then consider whether slow codes might be justified as a form of ethical disobedience against legislative and judicial overreach that compels harmful care. Finally, we will critically examine claims that time-limited trials of futile CPR represent an ethically acceptable compromise.