Defending the Slow Code

At the end of 2011, Lantos and Meadow published “Should the ‘Slow Code’
Be Resuscitated?” in AJOB.  (Lantos also discusses the article in this Bioethics
Channel podcast.)  I applaud Lantos
and Meadow for defending the slow code (or at least the short code).  As John Stuart Mill said in defending freedom of
expression:

1. First, if any opinion is compelled to silence,
   that opinion may, for aught we can certainly know, be true. To deny this is to assume
   our own infallibility.             


2. Secondly, though the silenced opinion be an
   error, it may, and very commonly does, contain a portion of truth; and since
   the general or prevailing opinion on any subject is rarely or never the whole
   truth, it is only by the collision of adverse opinions that the remainder of
   the truth has any chance of being supplied


3. Thirdly, even if the received opinion be not
   only true, but the whole truth; unless it is suffered to be, and actually is,
   vigorously and earnestly contested, it will, by most of those who receive it,
   be held in the manner of a prejudice, with little comprehension or feeling of its
   rational grounds.


4.  Fourthly, the meaning of the doctrine itself
   will be in danger of being lost, or enfeebled, and deprived of its vital effect
   on the character and conduct: the dogma becoming a mere formal profession,
   inefficacious for good, but cumbering the ground, and preventing the growth of
   any real and heartfelt conviction, from reason or personal experience. 

Still, I cannot agree with Lantos & Meadow’s core thesis.  I just stomach the lack of transparency.   And I
am too aware that even well-meaning subterfuge is the too-common breeding
ground for the operation of bias and prejudice. 
In short, the risks are too high. 

But there is something else in the same Lantos and Meadow article that
I really like:  a summary of the three
approaches to futility disputes:

•          Conversational – try to convince the surrogate


•          Deferential – accede to the surrogate’s wishes


•          Confrontational – refuse and override the
  surrogate

The conversational approach is always appropriate and should always be
undertaken first.  If, in the rare
instance in which a conversational
approach is not successful, a deferential
approach might sometimes be appropriate. 
A common example is the classic short-term accommodation until the out-of-town
relative can arrive at the hospital to say “goodbye.”  Other times, a confrontational approach is most appropriate.  Too often, however, providers take a deferential
approach, when a confrontational approach would be most appropriate.