DNR Orders and Medical Futility

Abstract

To the Editor. —In the Editorial 1 regarding the study by Dr Curtis and colleagues, 2 Ms Alpers and Dr Lo note that the study may underestimate problems experienced at institutions without the bioethical experience of the setting of Curtis and colleagues. Specifically, I believe this to be true: in hospitals where physicians are not experienced with futility decisions, the becomes the predominant method of limiting the inappropriate use of CPR. A slow code is distinguished from other attempts at CPR by its purpose: to appear as a resuscitative effort but without the intention of therapeutic benefit for the patient. A slow code feigns medical therapy and serves nonmedical purposes such as avoiding the perceived legal risks of writing a DNAR order based on futility. During my residency training in internal medicine, completed in 1993 in New York City, the use of slow codes was common, while