Considerations in Patients With Cardiac Implantable Electronic Devices at End of Life.
Since the introduction of implantable cardiac pacemakers in 1958 and implantable cardioverter-defibrillators in 1980, these devices have been proven to save and prolong lives. Pacemakers, implantable cardioverter-defibrillators, and cardiac resynchronization therapy are deemed life-sustaining therapies. Despite these life-saving technologies, all patients ultimately will reach the end of their lives from either their heart disease or development of a terminal illness. Clinicians may be faced with patient and family requests to withdraw these life-sustaining therapies. The purpose of this article is to educate clinicians about the legal and ethical principles that underlie withdrawal of life-sustaining therapies such as device deactivation and to highlight the importance of proactive communication with patients and families in these situations.
Melanie T. Gura is Director, Pacemaker & Arrhythmia Services, Northeast Ohio Cardiovascular Specialists, Towbridge Dr, Hudson, OH 44236 (meltg@aol.com).
Melanie T
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D026686:Beneficence; D003657:Decision Making / Q000941:ethics*; D017147:Defibrillators, Implantable; D006801:Humans; D007258:Informed Consent; D010138:Pacemaker, Artificial; D012935:Social Justice; D013727:Terminal Care / Q000941:ethics* / Q000331:legislation & jurisprudence*; D028761:Withholding Treatment / Q000941:ethics* / Q000331:legislation & jurisprudence*