Purely performative resuscitation: Treating the patient as an object.

Abstract

Despite its prevalence today, the practice of purely performative resuscitation (PPR)-paradigmatically, the "slow code"-has attracted more critics in bioethics than defenders. The most common criticism of the slow code is that it's fundamentally deceptive or harmful, while the most common justification offered is that it may benefit the patient's loved ones, by symbolically honoring the patient or the care team's relationship with the family. I argue that critics and defenders of the slow code each have a point. Advocates of the slow code are right that not all PPR is wrongly deceptive or harmful to the patient or his family and that the symbolic aspect of medicine is itself morally significant. But the critics are also correct: slow codes are prima facie wrong. I argue that pursuing a slow code amounts to treating the patient as a tool for others' benefit-hence, treating him as an object-and that this instrumentalizing quality constitutes one core prima facie wrong of the practice. I also build a case for the idea that the slow code may not always be all-things-considered wrong, specifying certain limited conditions under which acts of PPR might ultimately be permissible. Thus, the symbolic dimension of medical treatment is indeed morally important, both in morally favorable and in morally problematic respects-namely, in its symbolic denial of the patient's humanity.