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“But I Have a Pacer…There Is No Point in Engaging in Hypothetical Scenarios”: A Non-Imminently Dying Patient’s Request for Pacemaker Deactivation

Published online by Cambridge University Press:  08 February 2024

Bridget A. Tracy ,
Rosamond Rhodes  and
Nathan E. Goldstein Open the ORCID record for Nathan E. Goldstein [Opens in a new window]
Bridget A. Tracy
Affiliation:
Department of Medicine, Hackensack Meridian School of Medicine, Nutley, NJ, USA
Rosamond Rhodes
Affiliation:
Medical Education Department, Icahn School of Medicine at Mount Sinai, New York, NY, USA
Nathan E. Goldstein*
Affiliation:
Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
*
Corresponding author: Nathan E. Goldstein; Email: nathan.goldstein@mssm.edu
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Abstract

In this case report, we describe a woman with advancing dementia who still retained decisional capacity and was able to clearly articulate her request for deactivation of her implanted cardiac pacemaker—a scenario that would result in her death. In this case, the patient had the autonomy to make her decision, but clinicians at an outside hospital refused to deactivate her pacemaker even though they were in unanimous agreement that the patient had capacity to make this decision, citing personal discomfort and a belief that her decision seemed out of proportion to her suffering. We evaluated her at our hospital, found her to have decision-making capacity, and deactivated her pacer resulting in her death about 9 days later. While some clinicians may be comfortable discussing patient preferences for device deactivation in patients who are imminently dying, we can find no reports in the literature of requests for device deactivation from patients with terminal diagnoses who are not imminently dying.

Keywords

dementiadevice deactivationpalliative caredecision-makingpacemakerpatient autonomy
Type
Research Article
Information
Cambridge Quarterly of Healthcare Ethics , First View , pp. 1 - 4
Copyright
© The Author(s), 2024. Published by Cambridge University Press

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References

Notes

1. Bevins, MB. The ethics of pacemaker deactivation in terminally ill patients. Journal of Pain and Symptom Management 2011;41(6):1106–10.Google Scholar

2. 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):1537–42Google Scholar.

3. Lampert, R, Hayes, DL, Annas, GJ, Farley, MA, Goldstein, NE, Hamilton, RM, 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(7):1008–26Google Scholar.

4. Kramer, DB, Ottenberg, AL, Mueller, PS. Management of cardiac electrical implantable devices in patients nearing the end of life or requesting withdrawal of therapy: Review of the Heart Rhythm Society 2010 consensus statement. Polish Archives of Internal Medicine 2010;120(12):497–502 Google Scholar.