Tuesday, February 11, 2014

Pacemakers and end of life issues

I've heard about this issue periodically, so I was interested to read the New Old Age Blog on the topic of disconnecting pacemakers. Paula Span's post,  A Decision Deferred: Turning Off the Pacemaker looks at the numbers of Americans with pacemakers and the fact that often a patient's advance directive is silent regarding whether to "turn off" a pacemaker. Consider this, a person dying with a working pacemaker may be shocked numerous times before death.  In a study done by Dr. Paul S. Mueller at Mayo's:

[T]he majority [in the study]  hadn’t recorded their desire to deactivate their cardiac devices. More than half — a comparatively high proportion — had done what health care providers perennially urge and had prepared advance directives, but only one of those documents made any mention of cardiac technology.

The article goes on to describe the situation of patients who want  to have deactivated the "pacemaker function"  that increases "a too-slow heartbeat".  The article also discusses the implications of turning off these devices -the actual as well as legal and moral issues.  So advance directives may need to specifically address the issue of if and when a patient wants a pacemaker or implanted defibrillator turned off.

The article about the study as well as accompanying commentary may be accessed in the Journal of the American Medical Association (JAMA) here. (subscription may be required).



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