Documented consent process for implantable cardioverter-defibrillators and implications for end-of-life care in older adults
David Bourget (Western Ontario)
David Chalmers (ANU, NYU)
Rafael De Clercq
Ezio Di Nucci
Jack Alan Reynolds
Learn more about PhilPapers
Journal of Medical Ethics 39 (2):94-97 (2013)
Implantable cardioverter defibrillators (ICDs) reduce mortality in selected patients at risk for life-threatening heart arrhythmias, and their use is increasingly common. However, these devices also confer risk for delivery of unexpected painful shocks during the dying process, thus reducing the quality of palliative care at the end of life. This scenario can be avoided by ICD deactivation in appropriate circumstances but patients will remain unaware of this option if not informed about it. It is not known how often end-of-life implications are discussed with patients prior to ICD implantation, when focus is primarily on the short-term potential complications of the device placement procedure itself. We conducted a retrospective chart review to determine how often end-of-life implications were discussed with patients as part of the informed consent process. We evaluated consent forms and related other chart documentation for 91 patients (ranging from age 60 to 89 years) undergoing first-time ICD placement at a mid-western academic medical center from 2006-2008. Only one chart documented any discussion of end-of-life implications, in a case where the issue was raised by a patient who noted that quality of life was their main focus. Consent was provided by a health care surrogate in only four of the 91 cases. In conclusion, patients giving consent for ICD implantation may be uninformed about the device's potential future impact on end-of-life care, the dying process, and the option for device deactivation. Truly informed consent requires that both short- and long-term potential implications be reviewed with patients
|Keywords||No keywords specified (fix it)|
|Categories||categorize this paper)|
Setup an account with your affiliations in order to access resources via your University's proxy server
Configure custom proxy (use this if your affiliation does not provide a proxy)
|Through your library|
References found in this work BETA
No references found.
Citations of this work BETA
No citations found.
Similar books and articles
Juan Pablo Beca, Eduardo Rosselot, René Asenjo, Verónica Anguita & Rafael Quevedo (2009). Deactivating Cardiac Pacemakers and Implantable Cardioverter Defibrillators in Terminally Ill Patients. Cambridge Quarterly of Healthcare Ethics 18 (3):236.
Josh McGuire (2009). Ethical Considerations When Working with Older Adults in Psychology. Ethics and Behavior 19 (2):112 – 128.
R. England, T. England & J. Coggon (2007). The Ethical and Legal Implications of Deactivating an Implantable Cardioverter-Defibrillator in a Patient with Terminal Cancer. Journal of Medical Ethics 33 (9):538-540.
Mary Beth Morrissey (2011). Expanding Consciousness of Suffering at the End of Life. Schutzian Research 3:79-106.
E.-S. Nahm & B. Resnick (2001). End-of-Life Treatment Preferences Among Older Adults. Nursing Ethics 8 (6):533-543.
Barbara Allen, Nancy Meyers, John Sullivan & Melissa Sullivan (2002). American Sign Language and End-of-Life Care: Research in the Deaf Community. [REVIEW] HEC Forum 14 (3):197-208.
Ines M. Barrio-Cantalejo, Pablo Simón-Lorda, Adoración Molina-Ruiz, Fátima Herrera-Ramos, Encarnación Martínez-Cruz, Rosa Maria Bailon-Gómez, Antonio López-Rico & Patricia Peinado Gorlat (2013). Stability Over Time in the Preferences of Older Persons for Life-Sustaining Treatment. Journal of Bioethical Inquiry 10 (1):103-114.
M. -J. Johnstone (2012). Bioethics, Cultural Differences and the Problem of Moral Disagreements in End-Of-Life Care: A Terror Management Theory. Journal of Medicine and Philosophy 37 (2):181-200.
A. Agard, R. Lofmark, N. Edvardsson & I. Ekman (2007). Views of Patients with Heart Failure About Their Role in the Decision to Start Implantable Cardioverter Defibrillator Treatment: Prescription Rather Than Participation. Journal of Medical Ethics 33 (9):514-518.
Christopher F. Barber (2012). End-of-Life Care for Children and Adults with Intellectual and Developmental Disabilities. Nursing Philosophy 13 (1):78-79.
Robert Sparrow & Linda Sparrow (2006). In the Hands of Machines? The Future of Aged Care. Minds and Machines 16 (2):141-161.
Mary Ann Baily (2011). Futility, Autonomy, and Cost in End-of-Life Care. Journal of Law, Medicine & Ethics 39 (2):172-182.
Melinda A. Lee, Linda Ganzini & Ronald Heintz (1993). The PSDA and Treatment Refusal by a Depressed Older Patient Committed to the State Mental Hospital. HEC Forum 5 (5):289-301.
H. Series (1996). The Older Person: Consent and Care. Journal of Medical Ethics 22 (6):364-365.
Added to index2012-11-09
Total downloads9 ( #375,442 of 1,911,814 )
Recent downloads (6 months)2 ( #323,440 of 1,911,814 )
How can I increase my downloads?