Navigation Links
Doctors' questions about end-of-life legalities may result in patient pain
Date:11/13/2008

WINSTON-SALEM, N.C. When treatment options dwindle or are exhausted, terminally ill-patients often opt for pain management and comfort over life-extending therapies. However, a team of researchers from Wake Forest University Baptist Medical Center, University of Rochester Medical Center and Unity Health System, report that a lack of thorough understanding about the laws governing end-of-life care may be leaving many medical providers with an ethical dilemma and causing some terminally-ill patients considerable, unnecessary pain.

The report, appearing in a recent issue of Mayo Clinic Proceedings, concerns the legal and ethical issues involved with deactivating an implantable cardioverter-defibrillator (ICD) in patients who are terminally-ill. The ICD is a small, battery-powered electrical impulse generator, much like a pacemaker, that is implanted in patients who are at risk of sudden cardiac death due to ventricular fibrillation. The device is programmed to detect cardiac arrhythmia and correct it by delivering a jolt of electricity, which is often lifesaving. However, the legality of deactivating the ICD in terminally-ill patients who request to stop receiving the therapy is not clearly written, the study shows, and may be causing doctors to subject dying patients to undue pain.

The results stem from a physician survey that collected information about doctors' knowledge and preferences regarding the medical, ethical and legal issues involved in caring for terminally-ill patients with an ICD.

In the brief, Vinodh Jeevanantham, M.D., of Wake Forest Baptist, and colleagues identify a general lack of knowledge among physicians concerning ICD therapy in terminally-ill patients that may result in extra suffering for them.

The ICD has become the most effective treatment for patients at high risk of life-threatening ventricular arrhythmias. It has been shown to improve survival, especially in elderly patients, by sensing changes in cardiac rhythm and delivering an electrical shock to the heart to restore normal rhythm.

Terminally-ill patients may be at increased risk of ICD shocks due to electrolyte disturbances, hypoxia and heart failure. It is estimated that more than 3 million people in North America are now eligible for an ICD. With a growing elderly population in the United States, clinicians are likely to care for an increasing number of elderly patients with ICDs.

The deactivation of an ICD, which may have been placed years before the onset of a terminal condition, may not be a clear-cut decision for patients, families, or physicians. Although physicians are aware that ICDs save lives by delivering an electrical shock and that such shocks are associated with considerable pain, busy clinicians may not always re-analyze the risk-benefit ratio of ICD therapy when their patient experiences a terminal illness, the report states. In this situation, life-prolonging therapy may no longer be desired. However, although guidelines for appropriate ICD use are readily available, a glaring deficiency exists regarding end-of-life care for patients with an ICD, according to the report, and the legality of deactivation is not clearly spelled out. There are also no clear-cut recommendations, Jeevanantham said.

Although voluntary refusal of treatment is a basic patient right, the study highlights a lack of clarity regarding the laws concerning ICD therapy in terminally-ill patients.

"While 64 of the physicians who participated in our survey had cared for terminally-ill patients with an ICD, they were unaware of any guidelines regarding deactivation of the device in such patients," the authors wrote.

Of the 204 surveys distributed within Unity Health System between February and May 2007, 87 were returned. Among the physicians who responded, 64 reported experience caring for a patient with an ICD and terminal illness. Forty physicians either thought it was illegal or were not sure if it was legal to deactivate an ICD in these circumstances.

However, if the physicians were to be reassured about the legality of discontinuing ICD therapy, 79 of these same respondents said that they would be willing to discuss voluntary ICD deactivation with their dying patients. On the other hand, 16 of the physicians surveyed thought such action was either unethical or possibly unethical, and 19 physicians were uncomfortable deactivating an ICD in a terminally-ill patient, even though 51 of the doctors reported believing that an ICD-delivered shock would be painful for the patient.

"Although patients are better able to tolerate the shock from the ICD with time, they may still find an ICD firing frightening and painful," the researchers stated in their report. "Our study showed that only 51 clinicians thought that the shock therapy would be uncomfortable. This finding highlights the importance of physician education regarding the ICD functioning, particularly symptoms that result from shock therapy.

"With increased knowledge about managing the withdrawal of this potentially life-prolonging therapy, physicians are likely to become more skilled at caring for dying patients with an ICD."


'/>"/>

Contact: Jessica Guenzel
jguenzel@wfubmc.edu
336-716-3487
Wake Forest University Baptist Medical Center
Source:Eurekalert

Related medicine news :

1. Doctors Reveal Biology of Beauty in New Book
2. WomenHeart Urges Women to Talk With Doctors About New Study Showing Statins Prevent Heart Attacks, Deaths
3. Andy Tate, North Star Resource Group Advisor, Named One of Medical Economics 150 Best Financial Advisors for Doctors
4. Northwestern Medical Faculty Foundation Signs Long-Term Agreement to be the Provider of Doctors for Northern Illinois Proton Treatment and Research Center
5. Central California Doctors Now Using Fast RapidArc(TM) Radiotherapy Technology to Battle Cancer
6. ENT doctors release national guideline on treatment for common cause of dizziness
7. Americas Pending Shortage of Cancer Doctors
8. Gather and Harvard Health Publications Launch New Programs to Bring Harvard Medical School Doctors Expertise Online
9. MSU doctors bring much-needed psychiatric care to rural areas via technology
10. Doctors Test Advanced Tool for Treating Prostate Cancer
11. The Doctors Company Launches Litigation Education Retreats to Assist Physicians Involved in Medical Litigation
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:2/13/2016)... ... ... DDi , a Makro company, makes it to ... in eClinical Solutions. DDi has built its solution competency with a unique blend ... DDi provides smarter technology for Clinical Development, Regulatory and Enterprise domains by providing ...
(Date:2/12/2016)... , ... February 12, 2016 , ... ... devoted exclusively to funding innovative lymphoma research and serving the lymphoma community through ... over 250 members of South Florida’s philanthropic community at its 10th anniversary Fashion ...
(Date:2/12/2016)... ... 2016 , ... Coco Libre, the maker of coconut water beverages with a ... Lounge Event. Coco Libre will offer musicians and celebrities the company’s signature Organic Coconut ... invitation-only gifting suite, held this year at the W Hollywood Hotel, has become a ...
(Date:2/12/2016)... ... February 12, 2016 , ... Fisher House Foundation Chairman ... John J. Lee, Nevada Military Support Alliance president Scott Bensing, and Peggy Kearns Director, ... VA Southern Nevada Healthcare System. This will be the first Fisher House in ...
(Date:2/12/2016)... ... February 12, 2016 , ... Young ... area, celebrates the beginning of the latest charity campaign in their community enrichment ... art. Donations to this worthy cause are currently being accepted at: http://artexpressioninc.org/ ...
Breaking Medicine News(10 mins):
(Date:2/12/2016)... , Kalifornien, 12. Februar 2016  Sequent ... der Aufnahme von Patienten für eine Studie zur ... Aneurysmen („WEB") speziell für die Behandlung von rupturierten ... , MD, Leiter der Neuroradiologie an der Universitätsklinik ... und Hauptprüfarzt der CLARYS-Studie hat den ersten Patienten ...
(Date:2/12/2016)... , Feb. 12, 2016  Eli Lilly and Company ... Court decided the Alimta® (pemetrexed disodium) vitamin regimen patent would ... the UK, France , Italy ... to dilute the product only with dextrose solution.  ... 2015, the UK Court of Appeal held that Lilly,s patent ...
(Date:2/12/2016)... BUDAPEST , Ungarn, February 12, 2016 ... ein Medizintechnikunternehmen, das sich auf den ungedeckten ... gab heute positive Ergebnisse seines klinischen Forschungsprogramms ... und Asthma-Patienten beschäftigt, ergab Verbesserungen ihrer respiratorischen ... Indiso ltd , ein Medizintechnikunternehmen, das ...
Breaking Medicine Technology: