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As End of Life Nears, What to Do With Implanted Defibrillators?
Date:5/14/2010

r a group of individuals with expertise in different areas," Lampert said. "It included an ethicist, a lawyer, a nurse and a psychiatrist."

The purpose of the statement "is to carry out a patient's wish to provide or withdraw therapy as the patient desires," said Dr. Richard Page, professor and chair of medicine at the University of Wisconsin and president of the Heart Rhythm Society.

Removing an implanted defibrillator near the end of life, "is not physician-assisted suicide or euthanasia," he stressed.

The statement, developed in cooperation with other organizations, including the American College of Cardiology and the American Heart Association, recommends above all that all patients with implanted electronic devices be encouraged to make advance directives.

"Ideally, you have the conversation and make the patient aware of his or her empowerment and what decision should be made before you get to this point," Page said.

Other provisions of the consensus statement:

  • All adult patients are assumed to be competent to make decisions on continuing or stopping treatment. When a patient lacks capacity, the decision can be made by a designated health care proxy.
  • Physicians or other caregivers cannot be compelled to carry out a procedure that conflicts with their ethical values. In such a case, the issue can be passed to a colleague who is willing to carry out the task.
  • The recommendations will give physicians and institutions a frame of reference, experts said. "At least now you have a consensus statement based on a number of perspectives and a literature review to provide guidance," Page said.

More information

To learn more about defibrillators, go to the U.S. National Heart, Lung, and Blood Institute.



SOURCES: Rache
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