Skip to main content
Log in

Never a Simple Choice: Claude S. Beck and the Definitional Surplus in Decision-Making About CPR

  • Published:
Medicine Studies

Abstract

Each time patients and their families are asked to make a decision about resuscitation, they are also asked to engage the political, social, and cultural concerns that have shaped its history. That history is exemplified in the career of Claude S. Beck, arguably the most influential researcher and teacher of resuscitation in the twentieth century. Careful review of Beck’s work discloses that the development and popularization of the techniques of resuscitation proceeded through a multiplication of definitions of death. CPR consequently remains unique among medical treatments, because it is indicated precisely when a person dies, depending always on how each event of death becomes defined practically by patients, families, and medical professionals present at the time. It is therefore as an occasion to manage a surplus of definitions of death, and not as an occasion to determine the physiological efficacy of resuscitation, that one should approach analysis of contemporary challenges in decision-making about resuscitation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Notes

  1. As Beck reached the end of his career, he also used this anecdote to craft an autobiographical narrative of himself as a medical pioneer. In the process, he aligned himself with innovators of the past such as Prevost and Battelli in Beck 1968; and William Harvey in Beck 1958, Beck and Leighninger 1960b, and 1961. On the genre of scientific autobiography see Graham 2004.

  2. In later papers, Beck presented this claim directly as a matter of physician–family relations, as a matter of responsibility to the widow who questions whether her husband need have died permanently: “Must we learn the technique of reversal? The dead man’s widow might ask you to do something at the moment of death…” Beck and Leighninger 1961; 21. As a result, one could argue that in Beck’s view, physicians were at least as responsible to the family as to the individual patient or the society as a whole.

  3. Against what is today called a “slow code” Beck wrote: “A surgeon and hospital cannot in most instances, be held directly accountable for a cardiac arrest. Nor can an unsuccessful attempt be regarded as an unsatisfactory performance. However, a good effort must be made in every case.” Mozen and Beck 1957: 56. Similar arguments persist to the present, i.e., that anything less than a full attempt undermines the cohesion and effectiveness of the team in providing future treatment. See for example Paris and Moore 2011 and Janvier and Barrington 2011.

  4. Following the development of external chest massage, this logic pervaded training in resuscitation throughout the 1960s, when trainees were instructed to attempt resuscitation in every case, regardless of expected failure, because the experience would improve the likelihood of successful reversal in the next case; as recounted in a personal email from H. Rex Greene MD to Daniel Brauner, 4 April 2011.

  5. The authors of a review essay recently suggested: “If, despite optimizing external chest compression, hemodynamics, neurological recovery, and overall survival do not improve, consideration should be given to revisiting open-chest cardiac massage whenever prolonged resuscitation is expected…As we strive to realize the goal of full neurological recovery after cardiac arrest, future investigations should examine the strategy of initiating open cardiac massage by trained individuals if closed-chest CPR for 15 min ≈ (or less) fails to resuscitate victims.” Cooper et al. 2006: 2845–2846.

  6. For a weblink to this movie, see the online appendix to Cooper et al. 2006.

References

  • Adelson, Lester, and William Hoffman. 1961. Sudden death from coronary artery disease: Related to a lethal mechanism arising independently of vascular occlusion or myocardial damage. Journal of the American Medical Association 176(2): 129–135.

    Article  Google Scholar 

  • Barber, R.F., and C.J.L. Madden. 1945. Historical aspects of cardiac resuscitation. American Journal of Surgery 70: 135–136.

    Article  Google Scholar 

  • Beck, Claude S. Undated. My life in heart surgery. Stanley A. Ferguson Archives of University Hospitals of Cleveland, Ohio.

  • Beck, Claude S. 1950. Treatment of cardiac arrest. Veterans Administration Technical Bulletin TB 10–65: 1–7.

    Google Scholar 

  • Beck, Claude S. 1953. Cardiac arrest and resuscitation. The Pennsylvania Medical Journal 56(11): 969–974.

    Google Scholar 

  • Beck, Claude J. 1961. Hearts too good to die. Journal of the American Medical Association 176(2): 141–142.

    Article  Google Scholar 

  • Beck, Claude S. 1962. Fatal heart attack. American Journal of Surgery 103: 157–158.

    Article  Google Scholar 

  • Beck, Claude S. 1940. Preoperative and postoperative care of patients with lesions of heart and of pericardium. Archives of Surgery 1151–11563.

  • Beck, Claude S. 1958. Coronary artery disease: A report to William Harvey 300 years Later. American Journal of Cardiology 38–45.

  • Beck, Claude S. 1968. The last great Northwest of surgery. The Ohio State Medical Journal 335–340.

  • Beck, Claude S., and David S. Leighninger. 1960a. Death after a clean bill of health: So-called “fatal” heart attacks and treatment with resuscitation techniques. Journal of the American Medical Association 174(2): 133–135.

    Article  Google Scholar 

  • Beck, Claude S., and David S. Leighninger. 1961. The coronary patient wants better treatment. Medical Times 89(1): 17–26.

    Google Scholar 

  • Beck, Claude S., and David S. Leighninger. 1962a. Anginal pain and fibrillating electricity-mobile components of coronary artery disease. The Journal of Cardiovascular Surgery 3(5): 337–350.

    Google Scholar 

  • Beck, Claude S., and David S. Leighninger. 1962b. Prevention of fibrillation and anginal pain by the beck operation. The Journal of Cardiovascular Surgery 5(3): 351–356.

    Google Scholar 

  • Beck, Claude S., and David S. Leighninger. 1962c. Reversal of death in good hearts. The Journal of Cardiovascular Surgery 3(5): 357–375.

    Google Scholar 

  • Beck, Claude S., and Frederick R. Mautz. 1937. The control of the heart beat by the surgeon. Annals of Surgery 106(4): 525–537.

    Article  Google Scholar 

  • Beck, Claude S., and H.J. Rand III. 1949. Cardiac arrest during anesthesia and surgery. Journal of the American Medical Association 141(7): 1230–1233.

    Article  Google Scholar 

  • Beck, Claude, W.H. Pritchard, and H.S. Feil. 1947. Ventricular fibrillation of long duration abolished by electric shock. Journal of the American Medical Association 135(15): 985–986.

    Article  Google Scholar 

  • Beck, Claude S., Elden C. Weckesser, and Frank M. Barry. 1956. Fatal heart attack and successful defibrillation: New concepts in coronary artery disease. Journal of the American Medical Association 161(5): 434–436.

    Article  Google Scholar 

  • Beck, Claude S. Letter to Donald W. Mortimer, December 8, 1959. Stanley A. Ferguson Archives of University Hospitals of Cleveland, Ohio.

  • Beck, Claude S, David S. Leighninger. 1959. Resuscitation for cardiac arrest. Postgraduate Medicine 516–527.

  • Beck, Claude S., and David S. Leighninger. 1960a. Hearts too good to die–our problem. The Ohio State Medical Journal 1221–1223.

  • Beck, Claude S., David S. Leighninger. 1960b. Should patients with coronary heart disease be treated by surgical operation? The Ohio State Medical Journal 809–815.

  • Bishop, Jeffrey, et al. 2010. Reviving the conversation around CPR/DNR. American Journal of Bioethics 10(1): 61–67.

    Article  Google Scholar 

  • Brauner, Daniel J. 2011. Later than sooner: A proposal for ending the stigma of premature DNR. Journal of the American Geriatrics Society 59: 2366–2368.

    Article  Google Scholar 

  • Cole, S.L., and E. Corday. 1956. Four-minute time limit for cardiac resuscitation. Journal of the American Medical Association 161: 1454–1458.

    Article  Google Scholar 

  • Cooper, Jonas A., Joel D. Cooper, and Joshua M. Cooper. 2006. Cardiopulmonary resuscitation: History, current practice, and future direction. Circulation 114: 2839–2849.

    Article  Google Scholar 

  • Crile, George and David H. Dolley. 1906. An experimental research into the resuscitation of dogs killed by anesthetics and asphyxia. Journal of Experimental Medicine 713–725.

  • Drought, Theresa S., and Barbara A. Koenig. 2002. Choice” in end-of-life decision-making: Researching fact or fiction? The Gerontologist 42(3): 114–128.

    Article  Google Scholar 

  • Ehlenbach, W.J., A.E. Barnato, R. Curtis, et al. 2009. Epidemiologic study of in-hospital cardiopulmonary resuscitation. New England Journal of Medicine 361: 22–31.

    Article  Google Scholar 

  • Fields, N.L. 1966. The CPR team in a medium sized hospital. American Journal of Nursing 66: 87–90.

    Google Scholar 

  • Gainty, Caitjan, et al. 2010. History matters. American Journal of Bioethics 10(1): 76–77.

    Article  Google Scholar 

  • Graham, Lesley. 2004. Scientific autobiography: Some characteristics of the genre. Anglais de Spécialité et Milieux Professionnels 43–44: 57–67.

    Google Scholar 

  • Hosler, Robert M. 1954. A manual on cardiac resuscitation. Springfield, IL: Charles C. Thomas Publisher.

    Google Scholar 

  • Janvier, Annie, and Keith Barrington. 2011. What is an “appropriate code”? The American Journal of Bioethics 11(11): 18–20.

    Article  Google Scholar 

  • Kouewnhoven, W.B., J.R. Jude, and G.G. Knickerbocker. 1960. Closed-chest cardiac massage. JAMA 173(10): 1064–1067.

    Article  Google Scholar 

  • Lantos, John D., and William L. Meadow. 2011. Should the “slow code” be resuscitated? American Journal of Bioethics 11(11): 8–12.

    Article  Google Scholar 

  • Laqueur, Thomas. 1983. Bodies, death and pauper funerals. Representations 1: 109–131.

    Article  Google Scholar 

  • Mozen, Herschel E., and Claude S. Beck. 1957. Are you ready to treat cardiac arrest? The Modern Hospital 89(5): 51–56.

    Google Scholar 

  • Paris, John J., and Michael Patrick Moore. 2011. The resuscitation of “slow codes”: Fraud, lies, and deception. The American Journal of Bioethics 11(11): 13–14.

    Article  Google Scholar 

  • Pernick Martin, S. 1988. Back from the grave: Recurring controversies over defining and diagnosing death in history. In Death: Beyond whole-brain criteria, philosophy and medicine series, ed. Richard M. Zaner, 17–74. Dordrecht and Boston: Kluwer Academic Publishers.

    Chapter  Google Scholar 

  • Pernick Martin, S. 1999. Brain death in a cultural context: The reconstruction of death 1967–1981. In The definition of death, ed. Stuart Youngner, Robert Arnold, and Renie Schapiro, 3–33. Baltimore: Johns Hopkins University Press.

    Google Scholar 

  • Rabkin, Mitchell T., G. Gillerman, and N. Rice. 1976. Orders not to resuscitate. NEJM 295: 364–366.

    Article  Google Scholar 

  • Severino, Severino P. 1961. Reprieve for heart victims. The Saturday Evening Post 23: 36–40.

    Google Scholar 

  • Stephenson Jr., E. Hugh, L. Corsan Reid, and J. William Hinton. 1953. Some common denominators in 1,200 cases of cardiac arrest. Annals of Surgery 137(5): 731–744.

    Article  Google Scholar 

  • Timmermans, Stefan. 2001. Hearts too good to die: Claude S. Beck’s contributions to life-saving. Journal of Historical Sociology 14(1): 108–131.

    Article  Google Scholar 

  • Truog, Robert D. 2010. The conversation around CPR/DNR should not be revived—at least for now. American Journal of Bioethics 10(1): 84.

    Article  Google Scholar 

  • Venneman, S.S., P. Narnor-Harris, M. Perish, and M. Hamilton. 2008. “Allow natural death” versus “do not resuscitate”: Three words that can change a life. Journal of Medical Ethics 34(1): 2–6.

    Article  Google Scholar 

  • “WRU’s Doctor Beck Retires Today.” Cleveland Plain Dealer 5 July 1965.

Audiovisual materials

  • The Choir of the Dead. Undated.

  • Heart attack death life again. Part I: Resuscitation technique. Part II: Two ways to die. Undated.

  • The Beck operation. An album of patients. Undated.

  • Coronary artery disease. Undated.

Download references

Acknowledgments

Work on this paper was supported in part by a grant to Daniel Brauner MD from the Greenwall Foundation. Additional thanks are due to the staff of the Beck Archives at the Dittrick Medical History Center, and anonymous reviews at Medicine Studies for their critical commentary.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Geoffrey Rees.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Rees, G., Gainty, C. & Brauner, D. Never a Simple Choice: Claude S. Beck and the Definitional Surplus in Decision-Making About CPR. Medicine Studies 4, 91–101 (2014). https://doi.org/10.1007/s12376-013-0086-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12376-013-0086-3

Keywords

Navigation