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

ing 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 th
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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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