DNR Orders and Medical Futility

To the Editor.  —In the Editorial¹ regarding the study by Dr Curtis and colleagues,² Ms Alpers and Dr Lo note that the study may "underestimate problems" experienced at institutions without the "distinguished" bioethical experience of the setting of Curtis and colleagues. Specifically, I believe this to be true: in hospitals where physicians are not experienced with futility decisions, the "slow code" becomes the predominant method of limiting the inappropriate use of CPR.A slow code is distinguished from other attempts at CPR by its purpose: to appear as a resuscitative effort but without the intention of therapeutic benefit for the patient. A slow code feigns medical therapy and serves nonmedical purposes such as avoiding the perceived legal risks of writing a DNAR order based on futility. During my residency training in internal medicine, completed in 1993 in New York City, the use of slow codes was common, while