Advertisement

Ethical Dilemmas and End-of-Life Choices for Patients with Implantable Cardiac Devices: Decisions Regarding Discontinuation of Therapy

  • Blair P. Grubb
  • Beverly Karabin
Arrhythmia

Opinion statement

It is our belief that a well-designed cardiac device management program should include end-of-life patient and family planning, addressing potential decisions regarding withdrawal of pacemaker and/or implantable cardioverter defibrillator therapy. Guided by the basic ethical and legal principles outlined in the article, it is the responsibility of the electrophysiologist and other involved health care providers to introduce this topic to patients, provide guidance and resources for decision making, and honor both patient and family requests.

Keywords

Cardiac Resynchronization Therapy Advance Care Planning Implantable Cardioverter Defibrillator Therapy Implantable Cardiac Defibrillator Cardiac Device 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Disclosure

B. Grubb is a consultant for Medtronic and has received honoraria from Biotronik. B. Karabin has received honoraria from Medtronic, and has received payment for development of educational presentations and had travel expenses covered by Medtronic Biotronik.

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.••
    Lampert R, Hayes D, Annas G, et al. HRS Expert Consensus Statement on the Management of Cardiovascular Implantable Electronic Devices (CIEDS) in patients nearing end of life or requesting withdrawal of therapy. Heart Rhythm. 2010;7:1008–26. CrossRefGoogle Scholar
  2. 2.
    Finlay E, Casarette D. Making difficult discussions easier: using prognosis to facilitate transitions to hospice. CA Cancer J Clin. 2009;59:250–63.PubMedCrossRefGoogle Scholar
  3. 3.
    Ahmad M, Bloomstein L, Roelke M, Bernstein A, Prasonette V. Patients’ altitudes toward implanted defibrillation shocks. Pacing Clin Electrophysiol. 2000;23(6):934–8.PubMedCrossRefGoogle Scholar
  4. 4.
    McGearly A, Eldergill A. Medicolegal issues arising when pacemaker and implantable cardioverter defibrillator devices are deactivated in terminally ill patients. Med Sci Law. 2010;50:40–4.CrossRefGoogle Scholar
  5. 5.
    Wu EB. The ethics of implantable devices. J Med Ethics. 2007;33:532–3.PubMedCrossRefGoogle Scholar
  6. 6.
    England R, England T, Coggon J. The ethical and legal implications of deactivating an implantable cardioverter-defibrillator in a patient with terminal cancer. J Med Ethics. 2007;33:538–40.PubMedCrossRefGoogle Scholar
  7. 7.••
    Kapa S, Mueller P, Hayes D, Assirvatham S. Perspectives on withdrawing pacemaker therapies at end of life: results of a survey of medical and legal professionals and patients. Mayo Clin Proc. 2010;85(11):981–90. PubMedCrossRefGoogle Scholar
  8. 8.•
    Kay GN, Bittner G. Deactivating implantable cardioverter defibrillators and permanent pacemakers in patients with terminal illness. Arrhythm Electrophysiol. 2009;336–339. This article presents a different perspective on device deactivation in patients at end of lifeGoogle Scholar
  9. 9.
    Pendersen SS, Van den Broek KC, Sears SF. Psychological intervention following implantation of an implantable defibrillator: a review and future recommendations. PACE. 2007;30:1546–54.Google Scholar
  10. 10.
    Hazelton AG, Sears SF, Kirian K, Matchett M, Shea J. Coping with my partner’s ICD and cardiac diseases. Circulation. 2009 Sept 8;e74.Google Scholar
  11. 11.
    Ferris FD, von Gunten CF, Emanuel LL. Competency in end-of-life care: last hours of life. J Palliative Med. 2003:605–13.Google Scholar
  12. 12.
    Sears SF, Sowell LD, Kuhl EA, Kovacs AH, Serber ER, Handberg E, et al. The ICD shock and stress management program: a randomized trial of psychosocial treatment to optimize quality of life in ICD patients. PACE. 2007;30(7):858–64.PubMedGoogle Scholar
  13. 13.
    Kramer DB, Kesselheim AS, Brock DW, Maisel WH. Ethical and legal views of physicians regarding deactivation of cardiac implantable electrical devices: a quantitative assessment. Heart Rhythm. 2010;7(11):1537–42.PubMedCrossRefGoogle Scholar
  14. 14.
    Back AL, Young JP, McCown E, Engleberg R, Vig E, Reinke L, et al. Abandonment at the end of life from patient, caregiver nurse and physician perspectives. Arch Int Med. 2009;169(5):474–9.CrossRefGoogle Scholar
  15. 15.
    Goldstein N, Mehta D, Teitelbaum E, Bradley E, Morrison RS. “It’s like crossing a bride” complexities preventing physicians from discussing deactivation of implantable defibrillators at end of life. J Gen Int Med. 2008;23(s1):2–6.CrossRefGoogle Scholar
  16. 16.
    Grubb BP. With a little more soul. Card Electrophysiol Rev. 2003;7:85–7.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.CardiologyUniversity of Toledo Medical CenterToledoUSA

Personalised recommendations