Cardiac arrest & resuscitation
Ethical Implications of the Slow Code: A Systematic Review of Ethics of Slow Codes in U.S. Hospitals
Authors' conclusion
Most ethics literature deems slow codes impermissible.
Study context
- Population
- Ethics literature (academic articles, commentaries, opinion pieces) on slow codes in US hospitalsarticles analysed
- Participants
- 34 participants
- Outcome
- Ethical positions on slow codes
Methodological detailsdual, independent screening, MEDLINE, Embase, CINAHL, Web of Science searched May 16, 2024, updated August 7, 2025, 12,863 articles screened after duplicate removal; empirical studies excluded
- Dual, independent screening
- MEDLINE, Embase, CINAHL, Web of Science searched May 16, 2024, updated August 7, 2025
- 12,863 articles screened after duplicate removal; empirical studies excluded
Pooled result
As reported in the abstract
Physicians ought to be allowed to refuse cardiopulmonary resuscitation (CPR) in futile cases (n = 21)
61.8%
Supported slow/partial codes when patients or families request full resuscitation (n = 8)
23.5%
Described nuanced approaches (n = 9)
26.5%
Further pooled results
Ethical concerns
- Deception, patient harm, violation of autonomy, paternalism, moral distress, legal considerations, communication breakdown
Original publication
Ethical Implications of the Slow Code: A Systematic Review of Ethics of Slow Codes in U.S. Hospitals. Crit Care Med. Published 25 June 2026. doi:10.
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