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Hearts of Hospice Patients Being Needlessly Shocked
Date:3/4/2010

oes not constitute euthanasia nor physician-assisted suicide nor is it likely to hasten death," the statement said. If the device also acts as a pacemaker, that function can be maintained, it said.

"We put out this statement in 2008 because we knew that it was becoming an increasingly important issue in dealing with patients at the end of life," said Jon Radulovic, vice president for communications at the National Hospice and Palliative Care Organization. "We recognize that many hospices have a way to go to put a policy in place. The research out of Mount Sinai reminds us of how important this issue is. We now know that a lot of work needs to be done out there in the provider community in meeting the recommendation."

A conversation about turning off a defibrillator because the end of life is near is not easy to begin, Goldstein said, and many hospices "do not have a systematic way of having a conversation about the possibility of turning off defibrillators."

Family members who observe hospice patients being shocked report feelings of fear, worry and helplessness and have been shown to have increased rates of anxiety and depression, he said.

Goldstein's team has developed a model policy for managing implanted defibrillators in hospice settings. It includes an informed-consent discussion with the family and information on handling the device in an emergency.

"What is remarkable about Dr. Goldsteins study is what it uncovered," said Dr. Paul S. Mueller, director of the program in professionalism at the Mayo Clinic, who has done research on defibrillators in the end-of-life setting. "Here you have patients who have been admitted to the hospice program because they have terminal illnesses or will not live six months."

"The defibrillator is a life-preserving device. Is that kind of treatment consistent with a hospice program oriented toward end-of-life care? It would seem to be inconsistent with the goal of hospi
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