Ethics of calling a Slow Code

Question 1

A slow code involves the administration of resuscitative processes on the patient in a moderate manner. The ethical issues in the case of Dr. Holbert and the family of Mrs. Gage include:

Deceit. Dr. Holbert is deceiving Mr. and Mrs. Gage because they believe that their son will recover, but the slow code weakens the health of the patient. 

Paternalism. Dr. Holbert made a decision from his beliefs which is against the wishes of Mr. and Mrs. Gage. The doctor violated the legal rights of Mr. and Mrs. Gage of making decisions on their son’s treatment. 

Patient-doctor relationship. The parents trust the doctors in treating their children. The parents will lose trust in the doctors after realizing the administration of the slow code. 

The Communication skills. Dr. Holbert did not find time to discuss the crucial issues on the child’s condition with Mr. and Mrs. Gage.

Question 2

The doctor opted for a slow code because the parents address them to do everything, but they should not resuscitate. In case the doctor does everything, the treatment will not benefit the child but will cause harm to him. A slow code can be a time-limited option that enables individuals to view it as a solution to the expectations of the parents (Ladd and Forman, 2011). The limited and less aggressive procedures are suitable in case the doctor thinks that they are practical. The doctor can involve the parents in decision-making to convince them that the slow code is the best option. The slow code can be termed as limited trial-run or resuscitation subject to the decision made by the doctor (Lantos and Meadow, 2011). 

Question 3

The doctor made the decisions independently without the consent of the parents. The doctor did not involve any party in deciding the slow code but did it individually. The doctor did not disclose the truth to the parents about the effects of the slow system. Dr. Holbert did not obtain the consent of administering the slow code from the parents. The physician made an important decision because he decided to use the slow system rather than doing everything or nothing. The doctor exercised negative accountability because he made the decision based on his beliefs without disclosing to the parents (Vaughn, 2017) . 

Dr. Holbert intended to balance the good of the child and the emotional needs of the parents. Health providers should not inflict intentional harm to the patients. In case the child could survive for a long time, the medical bills could be high because he could stay in the intensive care unit. The doctor intended to protect the well-being of the child, Mr. and Mrs. Gage financial resources and support them emotionally (Vaughn, 2017) .

The doctor exercised fairness between the parents and the child. The doctor intended to prevent the child from going through pain in case they administered treatment which could not be effective. He wanted to support the feelings of the parents because the child could not get well (Vaughn, 2017) . 

Question 4

The theory of Ross on prima facie duties comprises of eights responsibilities that should be used to solve ethical dilemmas. The prima facie responsibilities include:

The duty of fidelity involves the fulfillment of promises and agreements without practicing deceit. 

The responsibility of repatriation deals with making up for the infliction of harm to others. 

Gratitude involves appreciating others for the good things they have done. 

The duty of non-injury involves avoidance of physical and psychological harm.

The role of harm-prevention due to the influence of others. 

The duty to do good to other individuals.

The responsibility of intelligence to promote ethical conduct.

The duty of exercising fairness to all individuals.

(Ross, 2007).

The prima facie theory can be used as a tool for decision-making to guide the parties to a case in their responsibilities before carrying out any action. The theory regulates the actions that should or should not be undertaken. The parties will settle on a decision that considers the interests of all the people involved in the situation. The theory takes into account the ethical aspects that revolve around a moral dilemma (Ross, 2007). 

Question 5

The doctor exercised his duty of non-injury in the situation. Dr. Holbert did not administer treatment to the child because it could be a painful process (Ross, 2007). The slow code did not inflict any physical pain to the child. The parents could be psychologically affected in case the doctor could disclose that the child could not survive in normal conditions. The decision for incorporating the slow code was appropriate concerning the responsibility of non-injury.

Dr. Holbert practiced the duty of fairness to the benefit of the child and parents. The doctor did not want the child to suffer by going through pain by receiving treatment which could not be effective. The doctor took into account the emotional well-being of the parents and did not disclose to them the future condition of their child (Ross, 2007). 

Question 6

The parents did not practice their duty of gratitude. They did not appreciate the health providers for the analysis they did on their child. The parents kept on pressurizing the doctors to do their best to save their child’s life (Ross, 2007). The health professionals were working to their best to save the life of the child, but the parents showed no appreciation. 

The parents did not fulfill their duty of harm-prevention because they insisted on delivering the child who could result in anomalies (Ross, 2007). The delivery process was life-threatening, but Mr. and Mrs. Gage persisted that it was appropriate. The child was born with abnormalities which could last for his lifetime. 

Question 7

The doctor fulfilled his duties, but the parents did not fulfill their responsibilities. If Mrs. Gage performed her obligation of harm-prevention, the child could not have been born. The doctor could not have carried out a slow code to prevent the loss of life and psychological effects on the parents. The root-cause of the situation is the violation of the duty to avoid harm. The parents could have followed the advice of the doctor from the beginning of the pregnancy period, but they just made assumptions (Cooper, 2010). The parents did not care about the life of their child which was in a critical condition.

Question 8

The actions taken by Dr. Holbert are ethically defensible because he exercised the duty of fairness and non-injury. The doctor took into account the emotional feelings of the child's parents. He applied justice through making a decision that would be just to the child and the parents (Dahlöf, 2013) .

Question 9

I would have administered a slow code because treatment would have caused pain and harm to the child who could not be useful in the long-run (Yates Jr, 2008) . I would inform the parents that doing everything would cause damage and pain to the child. The slow code was the appropriate option instead of doing everything or nothing (Curtis, 2012).

References

Cooper, S. (2010). Taking No for an Answer: Refusal of Life-Sustaining Treatment. Virtual Mentor , 12 (6), 444.

Curtis, J. R. (2012). The use of informed assent in withholding cardiopulmonary resuscitation in the ICU. Virtual Mentor , 14 (7), 545.

Dahlöf, C. (2013). Ethical considerations in biomedical research: A personal view. Cephalalgia , 33 (8), 507-511.

Lantos, J.D., Meadow, W.L. (2011) Should the “slow code” be resuscitated? American of Journal Bioethics .11 (11), 12. 

Ladd, R.E, Forman, E.N. (2011) Why not a transparent slow code? American of Journal Bioethics .11 (11), 30. 

Ross, W. D. (2007). Foundations of ethics: The Gifford lectures delivered in the University of Aberdeen, 1935-6 . S.l.: Read Books.

Vaughn, L. (2017). Bioethics: Principles, issues, and cases .

Yates Jr, F. D. (2008). Medical Decision Making for the Marginally Viable Infant. Virtual Mentor , 10 (10), 673.