title: How long is long enough, and have we done everything we should?--Ethics of calling codes.
abstract: 'Calling' a code can be an ambiguous undertaking. Despite guidelines and the medical literature outlining when it is acceptable to stop resuscitation, code cessation and deciding what not to do during a code, in practice, is an art form. Familiarity with classic evidence suggesting most codes are unsuccessful may influence decisions about when to terminate resuscitative efforts, in effect enacting self-fulfilling prophesies. Code interventions and duration may be influenced by patient demographics, gender or a concern about the stewardship of scarce resources. Yet, recent evidence links longer code duration with improved outcomes, and advances in resuscitation techniques complicate attempts to standardise both resuscitation length and the application of advanced interventions. In this context of increasing clinical and moral uncertainty, discussions between patients, families and medical providers about resuscitation plans take on an increased degree of importance. For some patients, a 'bespoke' resuscitation plan may be in order.
authors.affiliation: Medical Humanities & Bioethics, Northwestern University Feinberg School of Medicine, Chicago, USA.
authors.forename: Primi-Ashley
authors.initials: PA
authors.lastname: Ranola
authors.affiliation: Department of Emergency of Medicine, University of Pennsylvania, Philadelphia, USA.
authors.forename: Raina M
authors.initials: RM
authors.lastname: Merchant
authors.affiliation: Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, USA.
authors.forename: Sarah M
authors.initials: SM
authors.lastname: Perman
authors.affiliation: Cardiology Division, University of Pennsylvania, Philadelphia, USA.
authors.forename: Abigail M
authors.initials: AM
authors.lastname: Khan
authors.affiliation: Department of Emergency of Medicine, University of Pennsylvania, Philadelphia, USA.
authors.forename: David
authors.initials: D
authors.lastname: Gaieski
authors.affiliation: Division of Medical Ethics, New York Univerity Langone Medical Center, New York, USA.
authors.forename: Arthur L
authors.initials: AL
authors.lastname: Caplan
authors.affiliation: Cardiovascular Medicine Division, Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, USA.
authors.forename: James N
authors.initials: JN
authors.lastname: Kirkpatrick
mesh_terms: D016223:Advance Directives / Q000941:ethics*; D001291:Attitude of Health Personnel; D016887:Cardiopulmonary Resuscitation / Q000941:ethics / Q000379:methods; D004632:Emergency Medical Services; D006323:Heart Arrest / Q000401:mortality / Q000517:prevention & control*; D006801:Humans; D018447:Medical Futility / Q000941:ethics* / Q000523:psychology; D016414:Resuscitation Orders / Q000941:ethics*; D028761:Withholding Treatment / Q000941:ethics* / Q000706:statistics & numerical data
keywords: Allocation of Health Care Resources; Attitudes Toward Death; Clinical Ethics; Decision-making; Living Wills/Advance Directives