Tuesday, 18 August 2026, 12-1 PM CDT, Zoom, Unpacking Bedside Bioethics

Ethical Disobedience: Harm, Futility, and the Slow Code

-
Zoom | Free | Open to All
Jason Adam Wasserman, PhD, HEC-C
Jason Adam Wasserman, PhD, HEC-C

RECORDING

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.

Learning Objectives: After this webinar, attendees will be able to:

  • Describe the conditions that give rise to the dilemma between providing futile or inappropriate CPR and unilaterally withholding it.
  • Identify and evaluate arguments for and against slow codes as an ethically permissible option in the face of demands for futile or inappropriate CPR.
  • Analyze the permissibility of slow codes within a non-ideal ethics framework, particularly with respect to legislative or judicial overreach.
  • Critically examine claims about time-limited trials of futile or inappropriate CPR as an ethically tolerable compromise.

References

  • Andersen, S. K., Butler, R. A., Chang, C. C. H., et al. (2023). Prevalence of long-term decision regret and associated risk factors in a large cohort of ICU surrogate decision makers. Critical Care, 27, 61. 
  • Andrist, E., Meadow, J., Lawal, N., & Laventhal, N. T. (2025). Cracking the code of the slow code: A taxonomy of slow code practices and their clinical and ethical implications. Bioethics, 39(4), 309–317.
  • Baker, R. (2025). Show and slow codes: A historical analysis of clinicians' adaptations to ethical overreach. Bioethics, 39(4), 318–326.
  • Baubin, M., Rabl, W., Pfeiffer, K. P., Benzer, A., & Gilly, H. (1999). Chest injuries after active compression–decompression cardiopulmonary resuscitation (ACD-CPR) in cadavers. Resuscitation, 43(1), 9–15.
  • Benjamin, M. (1990). Splitting the difference: Compromise and integrity in ethics and politics. University Press of Kansas.
  • Berlin, J. (2012). Wrong directive: Legal shifts on end-of-life care concern physicians. Texas Medicine, 117(3), 30–34. 
  • Childress, J. F. (1985). Civil disobedience, conscientious objection, and evasive noncompliance: A framework for the analysis and assessment of illegal actions in health care. Journal of Medicine and Philosophy, 10(1), 63–83.
  • Crutchfield, P., & Wasserman, J. A. (2025). Revisiting slow codes [Editorial]. Bioethics, 39(4), 307–308.
  • Crutchfield, P. (2025). Moral dilemmas and slow codes. Bioethics, 39(4), 359–367.
  • Dunham, G. M., Perez-Girbes, A., Bolster, F., Sheehan, K., & Linnau, K. F. (2018). Use of whole-body CT to detect patterns of CPR-related injuries after sudden cardiac arrest. European Radiology, 28(10), 4122–4127.
  • Grosso, M. B., & Nicolas, P. (2025). Are slow codes uniquely deceptive? Bioethics, 39(4), 350–358.
  • Hellevuo, H., Sainio, M., Nevalainen, R., Huhtala, H., Olkkola, K. T., Tenhunen, J., & Hoppu, S. (2013). Deeper chest compression—More complications for cardiac arrest patients? Resuscitation, 84(6), 760–765.
  • Janvier, A., & Barrington, K. (2011). What is an 'appropriate code'? American Journal of Bioethics, 11(11), 18–20.
  • Kisner, J. (2021, January/February). What the chaos in hospitals is doing to doctors. The Atlantic. https://www.theatlantic.com/magazine/archive/2021/01/covid-ethics-committee/617261/
  • Kon, A. A. (2011). Informed non-dissent: A better option than slow codes when families cannot bear to say ‘let her die.’ American Journal of Bioethics, 11(11), 22–23.
  • Kralj, E., Podbregar, M., Kejžar, N., & Balažič, J. (2015). Frequency and number of resuscitation-related rib and sternum fractures are higher than generally considered. Resuscitation, 93, 136–141.
  • Krischer, J. P., Fine, E. G., Davis, J. H., & Nagel, E. L. (1987). Complications of cardiac resuscitation. Chest, 92(2), 287–291.
  • Ladd, R. E., & Forman, E. N. (2011). Why not a transparent slow code? American Journal of Bioethics, 11(11), 29–30.
  • Lantos, J. D., & Meadow, W. L. (2011). Should the ‘slow code’ be resuscitated? American Journal of Bioethics, 11(11), 8–12.
  • Mayer, P. A. (2025). Slow codes without regret. Bioethics, 39(4), 378–380.
  • McLennan, S., Bak, M., & Knochel, K. (2025). Slow codes are symptomatic of ethically and legally inappropriate CPR policies. Bioethics, 39(4), 327–336.
  • Morrison, W., & Feudtner, C. (2011). Quick and limited is better than slow, sloppy, or sly. American Journal of Bioethics, 11(11), 15–16.
  • Piscitello, G. M., Kapania, E. M., Kanelidis, A., Siegler, M., & Parker, W. F. (2021). The use of slow codes and medically futile codes in practice. Journal of Pain and Symptom Management, 62(2), 326–335.
  • Pope, T. M. (2007). Medical futility statutes: No safe harbor to unilaterally refuse life-sustaining treatment. Tennessee Law Review, 75(1), 1–81.
  • Pourmand, A., Hill, B., Yamane, D., & Kuhl, E. (2019). Approach to cardiopulmonary resuscitation-induced consciousness: An emergency medicine perspective. American Journal of Emergency Medicine, 37(4), 751–756.
  • Sprengholz, P. (2025). Public preferences regarding slow codes in critical care. Bioethics, 39(4), 337–342.
  • Tarasenko-Struc, A. (2025). Purely performative resuscitation: Treating the patient as an object. Bioethics, 39(4), 343–349.
  • Wasserman, J. A. (2025). Slow codes as ethical disobedience. Bioethics, 39(4), 368–374.
  • Wasserman, J. A., & Crutchfield, P. (under review). Time-limited trials are not an ethical compromise for futile or inappropriate CPR.
  • Zhou, X., & Sun, B. (2024). CPR-induced consciousness during ventricular fibrillation: Case report and literature review. Emergency Medicine International, 2024, Article 6674921.

Speaker(s)

Jason Adam Wasserman, PhD, HEC-C, is a Professor in the Department of Health Humanities and Bioethics at the University of Rochester School of Medicine and Dentistry, where he also serves as Director of Education. His scholarly work centers on the problems that arise when ethical theories encounter the complicating realities of clinical practice.

Dr. Wasserman’s research addresses some of the most contested problems in contemporary clinical ethics. He has written on the proper scope of conscientious objection — arguing that conscience protections apply to healthcare institutions as well as to individual clinicians — and on the standards governing treatment decisions for patients who cannot speak for themselves, including those with diminished or absent decision-making capacity. His work in pediatric ethics examines parental authority, the best-interest standard, the normative status of pediatric assent.

Dr. Wasserman is also a scholar of the medical humanities, with sustained attention to how the darker corners of the history of medicine continue to shape the foundations of contemporary medicine and bioethics. His work on medicine and the Holocaust examines questions of human dignity and its role in medical ethics.

His book Social and Behavioral Science for Health Professionals (2021) explored the various ways that sociological insights can be applied in clinical practice. His scholarship has appeared in The New England Journal of Medicine, Pediatrics, JAMA Pediatrics, Social Science and Medicine, Bioethics, the American Journal of Bioethics, The Hastings Center Report, and the Journal of Medical Ethics, among other venues.