title: Normativity under change: Older persons with implantable cardioverter defibrillator.
abstract: BACKGROUND
  In modern society, death has become 'forbidden' fed by the medical technology to conquer death. The technological paradigm is challenged by a social-liberal political ideology in postmodern Western societies. The question raised in this study was as follows: Which arguments, attitudes, values and paradoxes between modern and postmodern tendencies concerning treatment and care of older persons with an implantable cardioverter defibrillator appear in the literature?
  
  
  OBJECTIVE
  The aim of this study was to describe and interpret how the field of tension concerning older persons with an implantable cardioverter defibrillator - especially end-of-life issues - has been expressed in the literature throughout the last decade.
  
  
  METHODS
  Paul Ricoeur's reflexive interpretive approach was used to extract the meaningful content of the literature involving qualitative, quantitative and normative literature. Analysis and interpretation involved naive reading, structural analysis and critical interpretation.
  
  
  METHODS
  The investigation complied with the principles outlined in the Declaration of Helsinki.
  The unifying theme was 'Normativity under change'. The sub-themes were 'Death has become legitimate', 'The technological imperative is challenged' and 'Patients and healthcare professionals need to talk about end-of-life issues'. There seems to be a considerable distance between the normative approach of how practice ought to be and findings in empirical studies.
  
  
  CONCLUSIONS
  Modern as well as postmodern attitudes and perceptions illustrate contradictory tendencies regarding deactivation of the implantable cardioverter defibrillator and replacement of the implantable cardioverter defibrillator in older persons nearing the end of life. The tendencies challenge each other in a struggle to gain position. On the other hand, they can also complement each other because professionalism and health professional expertise cannot stand alone when the patient's life is at stake but must be unfolded in an alliance with the patient who needs to be understood and accepted in his vulnerability.
authors.affiliation: Aarhus University Hospital, Denmark jette.svanholm@skejby.rm.dk.
authors.forename: Jette Rolf
authors.initials: JR
authors.lastname: Svanholm
authors.affiliation: Aarhus University Hospital, Denmark.
authors.forename: Jens Cosedis
authors.initials: JC
authors.lastname: Nielsen
authors.affiliation: Aarhus University Hospital, Denmark.
authors.forename: Peter Thomas
authors.initials: PT
authors.lastname: Mortensen
authors.affiliation: Aarhus University Hospital, Denmark.
authors.forename: Charlotte Fuglesang
authors.initials: CF
authors.lastname: Christensen
authors.affiliation: Aarhus University Hospital, Denmark.
authors.forename: Regner
authors.initials: R
authors.lastname: Birkelund
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000066491:Clinical Decision-Making / Q000941:ethics*; D017147:Defibrillators, Implantable / Q000941:ethics*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D036301:Qualitative Research; D016079:Refusal to Treat / Q000941:ethics; D013727:Terminal Care / Q000941:ethics*
keywords: Dilemmas; end of life; ethics; implantable cardioverter defibrillator; older people; sociology