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

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