Time-limited trials are not an ethical compromise for physiologically futile CPR

Refusal to offer cardiopulmonary resuscitation (CPR) can provoke conflict and distress, even when the medical team judges it to be physiologically futile (PF). Some authors have argued that a time-limited trial of CPR—where it is performed to standard protocol but stopped after a short interval—represents an ethically tolerable compromise. Proponents argue that this approach is sincere and transparent, defuses conflict with families, and limits the harms of more protracted resuscitation attempts. In this article, we evaluate such claims, contending that time-limited codes (TLCs) of PF-CPR do not meet standards of veracity, do not significantly reduce harms, and, even if they were to satisfy a family’s desire for CPR, do so by displacing more fundamental obligations to the patient themselves. We conclude that this is not an ethical strategy for managing conflict about code status in the critical care setting.