title: Withdrawal of cardiac medications and devices.
abstract: Withdrawal of life-sustaining therapies such as cardiac medications, pacemakers, internal cardioverter defibrillators, and ventricular assist devices occurs in patients with advanced cardiac disease as goals of treatment transition from active to less aggressive. This article defines life-sustaining therapies and describes ethical and legal considerations related to withdrawal of cardiac medications and cardiac devices. Healthcare providers need to anticipate clinical situations in which implantable cardiac devices and medications are no longer desired by patients and/or are no longer medically appropriate. Discussions are important between patients, families, and healthcare providers that focus on each patient's condition, prognosis, advance directives, goals of care, and treatment options. Critical care nurses support each patient and his or her family and work with other members of the healthcare team to achieve a peaceful death.
authors.affiliation: University of Maryland School of Nursing, USA. debralyn@comcast.net
authors.forename: Debra Lynn-McHale
authors.initials: DL
authors.lastname: Wiegand
authors.forename: Peggy G
authors.initials: PG
authors.lastname: Kalowes
mesh_terms: D000328:Adult; D032722:Advance Care Planning / Q000941:ethics / Q000458:organization & administration; D000368:Aged; D002317:Cardiovascular Agents / Q000627:therapeutic use; D003142:Communication; D003422:Critical Care / Q000941:ethics / Q000458:organization & administration* / Q000523:psychology; D017147:Defibrillators, Implantable; D005190:Family / Q000523:psychology; D005260:Female; D006331:Heart Diseases / Q000628:therapy*; D006353:Heart-Assist Devices; D006801:Humans; D007258:Informed Consent; D008297:Male; D024802:Nurse's Role / Q000523:psychology; D010138:Pacemaker, Artificial; D010344:Patient Advocacy; D018579:Patient Selection; D011368:Professional-Family Relations; D011379:Prognosis; D019727:Proxy; D013727:Terminal Care / Q000941:ethics / Q000458:organization & administration* / Q000523:psychology; D028761:Withholding Treatment / Q000941:ethics / Q000331:legislation & jurisprudence
chemical_list: D002317:Cardiovascular Agents