My Patient Wants Me to Turn Off Their Cardiac Rhythm Device

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Monday, April 4, 2:30-3:30 PM

Last year, the Heart Rhythm Society issued a consensus statement that elucidates the issues for physicians in deactivating implanted defibrillators and pacemakers when terminally ill patients request it.

The authors of the statement said part of the intention of the document is to make clinicians aware of the legal, ethical and religious principles, which underlie withdrawal of life-sustaining therapies, and to highlight the importance of proactive communication by the clinician to minimize suffering as the end of life nears for patients with these devices. They also want the document to serve as a management scheme to guide the clinician in assisting a patient with a request to withdraw device therapy.

The statement clarifies that "legally and ethically, carrying out a request to withdraw life-sustaining treatment is neither physician-assisted suicide nor euthanasia." It states further that a patient with "decision-making capacity has the legal right to refuse or request the withdrawal of any medical treatment or intervention, regardless of whether he or she is terminally ill, and regardless of whether the treatment prolongs life and its withdrawal results in death."

A survey published last year in Heart Rhythm Journal found that a majority of internists are not comfortable conducting end-of-life discussions about deactivating pacemakers and ICDs. The surveyed revealed that 25 to 49 percent of physicians considered deactivation of pacemakers and ICDs to be morally distinct from the withdrawal of other life-sustaining therapies. Compared to deactivation of an ICD, physicians more often characterized deactivation of a pacemaker in a pacemaker-dependent patient as physician-assisted suicide or euthanasia.

This session promises to drive home the salient points about these end-of-life issues. It's incumbent that cardiologists understand the issues, and it is even more important that they begin to educated their medical colleagues so that sound advice can be given to these patients throughout the medical system.

Speaker Information

  • Susan S. Kim, MD, Northwestern University Feinberg School of Medicine, Chicago – Case Presenter
  • David B. DeLurgio, MD, The Emory Clinic, Atlanta -- Panelist
  • Melanie T. Gura, RN, Northeast Ohio Cardiovascular Specialists, Akron, Ohio -- Panelist
  • Brian Olshansky, MD, University of Iowa College of Medicine, Iowa City -- Panelist