The human brain’s ongoing activity is characterized by intrinsic networks of coherent fluctuations, measured for example with correlated functional magnetic resonance imaging signals. So far, however, the brain processes underlying this ongoing blood oxygenation level dependent (BOLD) signal orchestration and their direct relevance for human behavior are not sufficiently understood. In this study, we address the question of whether and how ongoing BOLD activity within intrinsic occipital networks impacts on conscious visual perception. To this end, backwardly masked targets were presented (...) in participants’ left visual field only, leaving the ipsi-lateral occipital areas entirely free from direct effects of task throughout the experiment. Signal time courses of ipsi-lateral BOLD fluctuations in visual areas V1 and V2 were then used as proxies for the ongoing contra-lateral BOLD activity within the bilateral networks. Magnitude and phase of these fluctuations were compared in trials with and without conscious visual perception, operationalized by means of subjective confidence ratings. Our results show that ipsilateral BOLD magnitudes in V1 were significantly higher at times of peak response when the target was perceived consciously. A significant difference between conscious and non-conscious perception with regard to the pre-target phase of an intrinsic-frequency regime suggests that ongoing V1 fluctuations exert a decisive impact on the access to consciousness already before stimulation. Both effects were absent in V2. These results thus support the notion that ongoing slow BOLD activity within intrinsic networks covering V1 represents localized processes that modulate the degree of readiness for the emergence of visual consciousness. (shrink)

In The Slow Professor, Maggie Berg and Barbara K. Seeber discuss how adopting the principles of the Slow movement in academic life can counter the erosion of humanistic education.

An introduction to slow gardening -- Garden psychology -- Carving out your space -- Plants: the real deal -- Nuts and bolts: universal garden practices -- Getting slow in the garden.

It is not unusual for patients or families to disagree with healthcare professionals (HCPs) over best treatment options. Conversation typically results and mutually agreeable choices are implemented. Rarely, but increasingly, patients or families will request, even demand, interventions the treating team believes will be ineffective (they will not achieve the intended goal) or inappropriate (the medical or moral harms clearly outweigh any potential benefits). One's duty as an HCP requires one to refuse such interventions, but resulting patient or family conflict (...) makes such refusals challenging, even traumatic, and HCPs often acquiesce. Some states have legal options that protect HCPs and their respective institutions when they make such unilateral choices, but the process is complex, time‐consuming, and emotionally fraught. In this paper, We describe one especially difficult case, using it as a paradigmatic example of when, and why, a slow code is sometimes, if rarely, justified. We also discuss strategies HCPs can use to reduce the need for this, admittedly problematic, solution. (shrink)

_Slow Cures and Bad Philosophers_ uses insights from the philosophy of Ludwig Wittgenstein to rethink bioethics. Although Wittgenstein produced little formal writing on ethics, this volume shows that, in fact, ethical issues permeate the entirety of his work. The scholars whom Carl Elliott has assembled in this volume pay particular attention to Wittgenstein’s concern with the thick context of moral problems, his suspicion of theory, and his belief in description as the real aim of philosophy. Their aim is not to (...) examine Wittgenstein’s personal moral convictions but rather to explore how a deep engagement with his work can illuminate some of the problems that medicine and biological science present. As Elliott explains in his introduction, Wittgenstein’s philosophy runs against the grain of most contemporary bioethics scholarship, which all too often ignores the context in which moral problems are situated and pays little attention to narrative, ethnography, and clinical case studies in rendering bioethical judgments. Such anonymous, impersonal, rule-writing directives in which health care workers are advised how to behave is what this volume intends to counteract. Instead, contributors stress the value of focusing on the concrete particulars of moral problems and write in the spirit of Wittgenstein’s belief that philosophy should be useful. Specific topics include the concept of “good dying,” the nature of clinical decision making, the treatment of neurologically damaged patients, the moral treatment of animals, and the challenges of moral particularism. Inspired by a philosopher who deplored “professional philosophy,” this work brings some startling insights and clarifications to contemporary ethical problems posed by the realities of modern medicine. _Contributors._ Larry Churchill, David DeGrazia, Cora Diamond, James Edwards, Carl Elliott, Grant Gillett, Paul Johnston, Margaret Olivia Little, James Lindemann Nelson, Knut Erik Tranoy. (shrink)

The act of slowness is by its very nature an implied reduction of physical engagement that one might argue has as much to do with impairment as it does with temporal devaluation. Yet when placed in a twenty-first century context there are a growing number of arguments that position slowness as a mediator of resistance to fast-paced communication transactions thus impacting on the ways in which human interaction coexists between digital technology and cultural immediacy. While it may be (...) suggestive to position this new emergence as a collective of technoanthropological treaties as found, for example, in the Slow Media Manifesto , there is an under-valued relation that I will discuss throughout this paper when considering the role that slow motion plays out as a condition rather than an effect of lens based practice. Discussion will integrate the ideas of Proust, Mearleu Ponty, and Murch with review of contributions from Wes Anderson, The Wachowski Siblings, Bill Viola, and Adam Magyar. These perspectives will align with discussion of my own lens-based practice with regards to a slow motion experimental called The 51 Paintings Suite. (shrink)

The fact that “natural” theories, i.e. theories which have something like an “idea” to them, are almost always linearly ordered with regard to logical strength has been called one of the great mysteries of the foundation of mathematics. However, one easily establishes the existence of theories with incomparable logical strengths using self-reference . As a result, PA+Con is not the least theory whose strength is greater than that of PA. But still we can ask: is there a sense in which (...) PA+Con is the least “natural” theory whose strength is greater than that of PA? In this paper we exhibit natural theories in strength strictly between PA and PA+Con by introducing a notion of slow consistency. (shrink)

Recent UK reports have revealed extensive evidence of unethical care practices. Older and vulnerable patients in some British health services have experienced appalling and avoidable suffering. Explanations for, and solutions to, these care failures have been proposed with wide-ranging recommendations. Many of these have direct implications for clinical ethics with additional frameworks for ethical values proposed, a heightened awareness of the moral culture of organisations acknowledged and a renewed interest in the ethics component of professional education debated. In this paper, (...) I suggest that we integrate insights from the slow movement into clinical ethics practice. Distinctions are made between fast and slow healthcare practice and between fast and slow ethics. I argue that, whilst there is a place for both, slow ethics enables us to assume a more positive stance in relation to ‘crisis’, and requires that we learn from past accounts and scholarship and consider the role of clinical ethics in sustaining caring cultures. (shrink)

The last decade has seen the transformation of the study of sexuality from a marginalized effort to a fully respected discipline at many major universities. There are numerous publications devoted solely to the topic and queer theory, a force to be reckoned with, has its own celebrities. Nonetheless, queer studies is considered to be the brainchild of the humanities, with the social sciences slowly coming around to apply its principles to empirical research. Long, Slow Burn, a powerful collection of essays (...) by Kath Weston, argues that social science has been talking about sex all along; to deny this one would have to overlook Kinsey's pioneering sex research in the 1950s, or the psychiatrist Evelyn Hooker's pathbreaking study of homosexuality, but also in the "sex talk" that lies at the heart of classic debates on kinship, inequality, cognition, and other foundational topics in the social sciences. What is different now, Weston claims, is the way sexuality has been isolated from other contemporary issues. Long, Slow Burn lays out a radically different approach to the study of sexuality. Not content with its ghettoization as a contained subfield, Weston refuses to draw an artificial line around sexuality. Her essays do not attempt to make sexuality a discrete object of study. Rather, each essay "sexes up" a conventional subject, such as kinship, race or labor, proving that once you start paying attention to sexuality, you can never look at social issues in the same way again. Long, Slow Burn offers an intervention, an attempt to see sexuality as it permeates the multiple fibers of our social fabric. It demonstrates that sexuality has always been a part of the social sciences, but more importantly, is the key to their future. (shrink)

Although cardiopulmonary resuscitation (CPR) was initially used very selectively at the discretion of clinicians, the use of CPR rapidly expanded to the point that it was required to be performed on all patients having in‐hospital cardiac arrests, regardless of the underlying condition. This created problems with CPR being clearly inadvisable for many patients. Do Not Resuscitate (DNR) orders emerged as a means of providing a transparent process for making decisions in advance regarding resuscitation, initially by patients and later also by (...) clinicians. Under hospital policies in many countries, however, CPR remains the default position for all patients having cardiac arrest in the hospital if there is no DNR order in place, regardless of whether CPR is medically indicated or in the patient's best interests. “Slow Codes” are the delayed or token efforts to provide CPR when clinicians feel CPR is futile or inappropriate. After giving a historical overview of the development and the changing use of CPR, we argue that more attention needs to be given to the cause of slow codes, namely, policies requiring CPR to be performed as the default action while simultaneously lacking implementing interventions such as advance care planning as a routine policy. This is ethically and legally inappropriate, and hospital policies should be modified to allow clinicians to consider whether CPR is appropriate at the time of arrest. Such a change requires a stronger emphasis on early recognition of patients for whom CPR is not in their best interests and to improve hospital emergency planning. (shrink)

Journal of Philosophy of Education, EarlyView.

Based on content externalism, the question of whether self-knowledge is authoritative or not has launched a real controversy in the philosophy of mind. Boghossian proposed slow switching argument in defense of incompatibility of the two views. This argument has been criticized by some philosophers through different approaches. Vahid is one of them. He claimed that Boghossian's argument appeals to some controversial assumptions without which it cannot achieve its conclusion. In this article, I criticize Vahid's response to slow switching argument and (...) show that self-knowledge in Vahid's response differs in having authority and therefore in function from that of Boghossian. (shrink)

There is a tendency to associate intelligence with speed. ‘Quick’ is a synonym for clever and suggests intellectual ability. ‘Slow’, by contrast, implies a want of intelligence, even stupidity. The slow child in the class is the one who is ‘behind’, the one who must ‘catch up’ with the others. This is symptomatic of a wider stress in our culture on getting things done quickly and ‘saving time’. It seems that fear of time running out often compels us into running (...) after it. Within philosophy however resources are available for challenging this perspective. (shrink)

In the first half of the 2000s, one project to restore the former Danube floodplain was carried out in Belene, a marginal town on the Bulgarian Danube. The aim of this article is to record the practices that were already in place before the interventions on the Danube, as part of a heterogeneous local knowledge that had an alternative vision to the scientific knowledge of experts involved in the restoration project. The data comes from qualitative interviews with locals and experts (...) implicated in this project, as well as ethnographic observations from the fieldwork I carried out in 2013–2014, 2020 and 2022. The conclusion is that without attempting to replace the scientific knowledge, the locals aim to impose, through their local knowledge, a sort of slow ecology that eases the pace of the restoration of the former Danube floodplains. (shrink)

Speed is an obvious facet of contemporary society, whereas slowness has often been dismissed as conservative and antimodern. Challenging a long tradition of thought, Lutz Koepnick instead proposes we understand slowness as a strategy of the contemporary--a decidedly modern practice that gazes firmly at and into the present's velocity. As he engages with late twentieth- and early twenty-first-century art, photography, video, film, and literature, Koepnick explores slowness as a critical medium to intensify our temporal and spatial experiences. (...) Slowness helps us register the multiple layers of time, history, and motion that constitute our present. It offers a timely mode of aesthetic perception and representation that emphasizes the openness of the future and undermines any conception of the present as a mere replay of the past. Discussing the photography and art of Janet Cardiff, Olafur Eliasson, Hiroshi Sugimoto, and Michael Wesely; the films of Peter Weir and Tom Tykwer; the video installations of Douglas Gordon, Willie Doherty, and Bill Viola; and the fiction of Don DeLillo, Koepnick shows how slowness can carve out spaces within processes of acceleration that allow us to reflect on alternate temporalities and durations. (shrink)

In this, journal, W. Buchholz gave an elegant proof of a characterization theorem for provably total recursive functions in the theory IDv for the v-times iterated inductive definitions . He characterizes the classes of functions by Hardy functions. In this note we will show that a slow growing analogue to the theorem can be obtained by a slight modification of Buchholz' proof.

This article is devoted to presenting the intermedia journalistic project called Out of Eden Walk and launched by American reporter Paul Salopek. Based on values such as journalistic reliability and the in-depth view of the reality, the project can be situated within the framework of the popular strands of slow journalism and slow travel. Salopek’s intention was to present Out of Eden Walk as an alternative to the rapidity of mass media communication and popular travel writing. The purpose of this (...) paper is to demonstrate the way in which Salopek uses media convergence mechanisms for creating an intermediary journalistic message, which is then distributed via various communication platforms based on both new media and traditional media. (shrink)

This study investigated the immediate effect of slow yoga breathing at 6 breaths per minute simultaneously on working memory performance and heart rate variability in yoga practitioners. A total of 40 healthy male volunteers performed a working memory task, ‘n-back’, consisting of three levels of difficulty, 0-back, 1-back, and 2-back, separately, before and after three SYB sessions on different days. The SYB sessions included alternate nostril breathing, right nostril breathing, and breath awareness. Repeated measures analysis of variance showed a significant (...) reduction in reaction time in 2-back condition immediately after ANB, RNB and BAW practices. Similarly, the accuracy was improved in the 0-back condition after RNB, and in the 2-back condition after ANB and RNB practices. These results suggest that SYB practice enhances cognitive abilities related to memory load and improves the functioning of cardiac autonomic activity, which is required for the successful completion of mental tasks.Trial registered in the Clinical Trials Registry of India. (shrink)

Biological studies have demonstrated that it is possible to slow the ageing process and extend lifespan in a wide variety of organisms, perhaps including humans. Making use of the findings of these studies, this article examines two problems concerning the effect of life extension on population size and welfare. The first—the problem of overpopulation—is that as a result of life extension too many people will co-exist at the same time, resulting in decreases in average welfare. The second—the problem of underpopulation—is (...) that life extension will result in too few people existing across time, resulting in decreases in total welfare. I argue that overpopulation is highly unlikely to result from technologies that slow ageing. Moreover, I claim that the problem of underpopulation relies on claims about life extension that are false in the case of life extension by slowed ageing. The upshot of these arguments is that the population problems discussed provide scant reason to oppose life extension by slowed ageing. (shrink)

Yoga is often presented as a ‘slow’ form of exercise. Yoga magazines are filled with advice about how to ‘slow down’. However, Ashtanga yoga is considered dynamic and ‘fast’—something that dates ba...

In the international bestseller, Thinking, Fast and Slow, Daniel Kahneman, the renowned psychologist and winner of the Nobel Prize in Economics, takes us on a groundbreaking tour of the mind and explains the two systems that drive the way we think. System 1 is fast, intuitive, and emotional; System 2 is slower, more deliberative, and more logical. The impact of overconfidence on corporate strategies, the difficulties of predicting what will make us happy in the future, the profound effect of cognitive (...) biases on everything from playing the stock market to planning our next vacation—each of these can be understood only by knowing how the two systems shape our judgments and decisions. -/- Engaging the reader in a lively conversation about how we think, Kahneman reveals where we can and cannot trust our intuitions and how we can tap into the benefits of slow thinking. He offers practical and enlightening insights into how choices are made in both our business and our personal lives—and how we can use different techniques to guard against the mental glitches that often get us into trouble. Winner of the National Academy of Sciences Best Book Award and the Los Angeles Times Book Prize and selected by The New York Times Book Review as one of the ten best books of 2011, Thinking, Fast and Slow is destined to be a classic. (shrink)

In this paper three senses of slow sport are demonstrated through three modalities of technical, and as such, it is found within a precise methodology. Self-awareness is defined by paying attention...

Adopting Gilles Deleuze and Felix Guattari's formulations of the rhizome, this article will examine a dynamic that lies between the film Japón's (Carlos Reygadas, 2002) vernacular specificities, European modernist aesthetics and cosmopolitan spectatorship. The article aims to reveal that Japón, along with other contemporary slow films from around the world, has the potential to reify a deterritorialising and reterritorialising encounter that rethinks a Eurocentric genealogical reading of world cinema and challenges a capitalist code of filmmaking.

The possibility for transnational democratic representation is a huge topic. This article is restricted to exploring two unconventional aspects. The first concerns ‘the representative claim’, extending one critical part of previous analysis of the assessment of such claims, especially by largely unelected transnational actors. The second, which strongly conditions the account of the first, concerns ‘slow theory’ as the way to approach building democratic models and, in particular, to approach transnational democratic representation. Keywords: slow politics; slow theory; transnational representation; democracy (...) and representation; slow movement. (shrink)

Slow codes—insincere attempts at resuscitation—are widely regarded in medicine and medical ethics as morally impermissible. My goal here is to enrich this special issue on the slow code with an argument for the permissibility of slow codes that is rooted in moral psychology. Specifically, if we take seriously the results from moral psychology, the slow code is not only permissible, it is often the best option. The context of the decision about whether to perform a slow code is analogous to (...) thoroughly investigated moral dilemmas such as the trolley problem. In particular, when the trolley problem is framed as a trilemma, it becomes clear that the decisional context of the slow code is analogous to the famous moral dilemma. Since in the trolley problem the choice analogous to the slow code is the best choice, the slow code may be the best choice when facing patient or family requests for futile CPR. In establishing this claim, I address a range of objections to the slow code. I conclude with an empirically supported explanation of the conventional wisdom. Resistance to the slow code doesn’t sprout from the act’s moral properties, but from moral judgments influenced by factors such as emotion, physical distance, and personal force. (shrink)

Purpose– The purpose of this paper is to examine how Slow Tech can support the celebration of the 20-year series of ETHICOMP conferences, with its ethical and societal focus, building on earlier descriptions of Slow Tech. The paper takes Slow Tech’s ideas a step further to explore how a roadmap and concrete checklist of activities can be developed.Design/methodology/approach– The paper is a thought leadership or conceptual piece. Its approach is based on a normative, qualitative discourse. It, nevertheless, indicates a shift (...) towards concrete actions.Findings– Extracting from a brief historical overview, the paper lays out the means of building a Slow Tech roadmap and a Slow Tech checklist of actions. It also investigates a number of the challenges that might face Slow Tech in the future.Research limitations/implications– The paper has implications for stakeholder fields as far-ranging as corporations, computing professional associations, universities and research institutions and end-users.Originality/value– As with other investigations of Slow Tech, the value of this paper is in its call for reflection followed by action. It provides a useful complement and counterbalance to an earlier paper by the same authors: “Slow Tech: a quest for good, clean and fair ICT” published inJournal of Information, Communication and Ethics in Society(Vol. 12, issue 2, pp. 78-92). (shrink)

With Slowing Metaphor Down: Elaborating Deliberate Metaphor Theory (henceforth SMD), Gerard J. Steen has given us a remarkable book, teeming with insights about metaphor use. The volume provides a...

The digital era in which we live has led to countless online social movements, all driven by emotions. This paper builds on fieldwork that stretched over 2 years, starting March 2020 as Norway went into lockdown due to COVID‐19. Emotions as experienced online seem to differ from those that are materially embodied or physically present among the studies' 25 young adults. Through two young women, this paper explores reflections on slow writing, holding a letter in their hands, in juxtaposition to (...) fast scrolling on their phones, receiving and sending messages and pictures. In the meetings between their hands and paper, their hands, and their phone screens, they sense time and experience emotions through touch and imaginaries. Amelia and Embla connect mind, body, and senses, as they share their understanding of touching what others have made by hand, imagining the thought behind the embodied materiality. (shrink)

Purpose– The purpose of this paper is to introduce the term Slow Tech as a way of describing information and communication technology that is good, clean and fair. These are technologies that are human centred, environmentally sustainable and socially desirable.Design/methodology/approach– The paper's approach is based on a qualitative discourse that justifies the introduction of Slow Tech as a new design paradigm.Findings– The limits of the human body, and the need to take into account human wellbeing, the limits of the planet (...) and stakeholders' interests in decision making, all suggest the need for a new paradigm, Slow Tech, in the design of ICT and ICT systems. Three scenarios are described as case studies.Practical implications– In order to prepare the next generation of researchers and computer professionals, many different actions need to be taken. Universities and colleges need to redesign education programmes for computer scientists and engineers by introducing subjects related to the social and ethical implications of computing, and computer professionals' associations need to introduce a code of ethics or ethical analysis into their members' career development. As a result, future computer professionals who are familiar with the Slow Tech approach will be able to collaborate much more easily across the kind of cross disciplinary teams suited to design human centred, sustainable and desirable technologies.Social implications– Rather than simply focusing on the role of computer professionals, all members of society are called to play a new role in the design of future ICT scenarios. Starting a societal dialogue that involves computer professionals, users, researchers, designers, ICT industrialists, and policy makers is very much needed.Originality/value– The value of this paper is in its call for reflection followed by action. Based on an holistic approach to the design of new ICT systems, the paper advocates a new starting point for systems design: it should be based on a long-term view of the desirability and social importance of technologies, their environmental impact and sustainability, and the fairness and equity of the conditions of workers involved in the computing manufacturing processes. (shrink)

Recent discussions of externalism about mental content have been dominated by the question whether it undermines the intuitively plausible idea that we have knowledge of the contents of our thoughts. In this article I focus on one main line of reasoning (the so-called 'slow switching argument') for the thesis that externalism and self-knowledge are incompatible. After criticizing a number of influential responses to the argument, I set out to explain why it fails. It will be claimed that the argument trades (...) on an ambiguity, and that only by incorporating certain controversial assumptions does it stand a chance of establishing its conclusion. Finally, drawing on an analogy with Benacerraf's challenge to Platonism, I shall offer some reasons as to why the slow switching argument fails to reveal the real source of tension between externalism and privileged self-knowledge. (shrink)

There are indications that simple reaction time might have slowed in Western countries, based on both cohort- and multi-study comparisons. A possible limitation of the latter method in particular is measurement error stemming from methods variance, which results from the fact that instruments and experimental conditions change over time and between studies. We therefore set out to measure the simple auditory reaction time (SRT) of 7,081 individuals (2,997 males and 4,084 females) born in Sweden 1959-1985 (subjects were aged between 27 (...) and 54 years at time of measurement). Depending on cut-offs and adjustment for ageing related slowing on SRT, the data suggest that SRT has increased between 3 and 16 ms in the 27 birth years covered in the present sample. The slowing is unlikely to be explained by attrition, as evaluated by comparing the general intelligence × birth-year interactions and standard deviations for both male participants and dropouts, utilizing military conscript cognitive ability data. The present result is consistent with previous studies employing alternative methods, and may result from several synergistic factors, such as possible recent micro-evolutionary trends favouring lower g in Sweden and the effects of industrially produced neurotoxic substances on peripheral nerve conduction velocity. (shrink)

The Slow Professor: Challenging the Culture of Speed in the Academy was published in 2016 to critical acclaim. Rejecting outright the marketisation of the modern university, the book proposed a countercultural approach which denounced the seductive imperatives to overwork and competition and called on academics to make a more deliberate moral choice. In this paper, I critically engage with The Slow Professor's ethical vision. I draw on the work of writers Sally Rooney, John Williams and David Foster Wallace in careful (...) exploration of ‘slowness’ and its cognate terms. I am interested not only in the importance of slowness for university academics but for students in the 21st century university. These students, as pointed out recently by Bruce Macfarlane, are made to carry a plethora of conflicting identities and yet it is perhaps more important that we begin to demand less of our students and not more. Thus, in an era of audit and accountability, this paper explores the possibilities for a less frenetic approach to university teaching and learning. (shrink)

The eukaryotic genome is a mosaic of eubacterial and archaeal genes in addition to those unique to itself. The mosaic may have arisen as the result of two prokaryotes merging their genomes, or from genes acquired from an endosymbiont of eubacterial origin. A third possibility is that the eukaryotic genome arose from successive events of lateral gene transfer over long periods of time. This theory does not exclude the endosymbiont, but questions whether it is necessary to explain the peculiar set (...) of eukaryotic genes. We use phylogenetic studies and reconstructions of ancestral first appearances of genes on the prokaryotic phylogeny to assess evidence for the lateral gene transfer scenario. We find that phylogenies advanced to support fusion can also arise from a succession of lateral gene transfer events. Our reconstructions of ancestral first appearances of genes reveal that the various genes that make up the eukaryotic mosaic arose at different times and in diverse lineages on the prokaryotic tree, and were not available in a single lineage. Successive events of lateral gene transfer can explain the unusual mosaic structure of the eukaryotic genome, with its content linked to the immediate adaptive value of the genes its acquired. Progress in understanding eukaryotes may come from identifying ancestral features such as the eukaryotic splicesome that could explain why this lineage invaded, or created, the eukaryotic niche. BioEssays 28:57–64, 2006. © 2005 Wiley Periodicals, Inc. (shrink)

Background: Cardio-pulmonary resuscitation is the default procedure during cardio-pulmonary arrest. If a patient does not want cardio-pulmonary resuscitation, then a do not attempt resuscitation order must be documented. Often, this order is not given; even if thought to be appropriate. This situation can lead to a slow code, defined as an ineffective resuscitation, where all resuscitation procedures are not performed or done slowly. Research objectives: To describe the perceptions of nurses working on internal medicine wards of slow codes, including the (...) factors associated with its implementation. Research design: This was a cross-sectional, descriptive study. Participants completed a personal characteristics questionnaire and the Perceptions and Factors of Slow Codes questionnaire designed for this study. Participants and research context: The sample was a convenience sample of nurses working on internal medicine wards in two Israeli hospitals. Ethical considerations: The study received ethical approval from both institutions, where data were collected and stored according to institutional policy. Findings: Most reported that resuscitations were conducted according to protocol (n = 90, 76.2%). Some took their time calling the code (n = 22, 18.3%), or waited by the bedside and did not perform cardio-pulmonary resuscitation (n = 45, 37.5%). Factors most associated with slow codes were poor patient prognosis (mean = 3.52/5, standard deviation = 1.27) and a low chance of patient survival (mean = 3.37/5, standard deviation = 1.21). Two-thirds (n = 76, 66.8%) reported that slow codes were done on their unit and the majority (n = 80, 69%) perceived slow codes as ethical. Discussion: This study confirms that slow codes are part of medical care on internal medicine wards, where most nurses perceive them as an ethical alternative. These perceptions are in contrast to most legal and ethical opinions expressed in the literature. Conclusion: Nurses should be educated about the legal and ethical implications of slow codes, and qualitative and quantitative studies should be conducted that further investigate its implementation. (shrink)

After briefly reviewing the historical development and ethical regulation of resuscitative technologies, this study probes why clinicians engage in the morally problematic practice of show and slow coding and why hospitals tolerate it? Studies conducted in 1995 and 2020 indicate that conscientious clinicians engage in these practices to protect their patients from abusive or futile resuscitation. And hospitals' clinical cultures tolerate these practices to protect conscientious clinicians from censure, dismissal, delicensing, or legal prosecution for withholding or withdrawing abusive or futile (...) resuscitative technologies without prior patient or surrogate consent. Show and slow coding evolved in American clinical cultures in the second half of the 20th century when closed‐chest cardiac massage, defibrillators, ventilators, and other resuscitative technologies raised seemingly novel ethical questions. To address these questions, bioethics commissions, healthcare societies, lawmakers, and a Roman Catholic Pope developed ethics standards requiring clinicians to obtain patient or surrogate consent before withholding or withdrawing resuscitative technologies. They thus conferred on patients an implicit right of resuscitation even if it was abusive and/or futile. Conscientious clinicians circumvented this implicit right by show and slow coding to protect patients from abusive resuscitation. Recognizing clinicians' benign intent, hospitals' clinical cultures tolerate show and slow coding as acts of conscience, akin to civil disobedience. Thus, rescinding ethics standards and laws requiring prior patient/surrogate consent for non‐resuscitation or for cessation of resuscitative technologies decisions should end show/slow coding. Such a reform should also recognize clinicians' right of conscientious refusal to perform CPR. (shrink)

Canada and California each introduced legislation to permit medical assistance in dying in June, 2016. Each jurisdiction publishes annual reports on the number of deaths that occurred under their respective legislations in the previous years. The numbers are disturbingly different. In 2021, 486 individuals died under California’s End of Life Option. In the same year 10,064 Canadians died under that country’s Medical Assistance in Dying (MAiD) legislation. California has a slightly larger population than Canada, and while medically assisted deaths as (...) a percentage of total deaths remained virtually unchanged in California from 2020-2021, Canada saw a 30% increase from 2020 to 2021. This essay examines some of the factors propelling Canada down the slippery slope of medically assisted suicide, as well as those that may be keeping California and other US jurisdictions from taking the slide. At a time of increasing pressure in many jurisdictions (both nationally and internationally) to liberalize access to medical assistance in dying, some lessons from this comparative analysis are offered. (shrink)