Individuals living with serious illness might request deactivation of a cardiac implantable electronic device for a variety of reasons. Discontinuation of implantable cardiac defibrillators and pacemakers are considered to be ethically sound procedures. However, healthcare professional comfort with discontinuation of different types of devices might vary. In this case we describe a veteran's request for pacemaker deactivation and our interdisciplinary team's response to this request, including evaluation of total suffering, ethical considerations, and mood symptoms at end-of-life.
BallentineJM. Pacemaker and defibrillator deactivation in competent hospice patients: an ethical consideration. Am J Hosp Palliat Care. 2005;22(1):14-19. doi:https://doi.org/10.1177/104990910502200106
3.
ZellnerRAAulisioMPLewisWR. Should implantable cardioverter-defibrillators and permanent pacemakers in patients with terminal illness be deactivated?. Circ Arrhythm Electrophysiol. 2009;2(3):340-344. doi:https://doi.org/10.1161/CIRCEP.109.848523
4.
MuellerPS. Clinicians’ views regarding deactivation of cardiovascular implantable electronic devices in seriously ill patients. Heart Rhythm. 2010;7(11):1543-1544. doi:https://doi.org/10.1016/j.hrthm.2010.08.020
5.
KramerDBOttenbergALGerhardsonS,et al.Just because we can doesn’t mean we should”: views of nurses on deactivation of pacemakers and implantable cardioverter-defibrillators. J Interv Card Electrophysiol. 2011;32(3):243-252. doi:https://doi.org/10.1007/s10840-011-9596-7
6.
KramerDBKesselheimASBrockDWMaiselWH. Ethical and legal views of physicians regarding deactivation of cardiac implantable electrical devices: a quantitative assessment. Heart Rhythm. 2010;7(11):1537-1542. doi:https://doi.org/10.1016/j.hrthm.2010.07.018
7.
MuellerPSJenkinsSMBramstedtKAHayesDL. Deactivating implanted cardiac devices in terminally ill patients: Practices and attitudes. Pacing Clin Electrophysiol. 2008;31(5):560-568. doi:https://doi.org/10.1111/j.1540-8159.2008.01041.x
8.
KramerDBMitchellSLBrockDW. Deactivation of pacemakers and implantable cardioverter-defibrillators. Prog Cardiovasc Dis. 2012;55(3):290-299. doi:https://doi.org/10.1016/j.pcad.2012.09.003
9.
McGearyAEldergillA. Medicolegal issues arising when pacemaker and implantable cardioverter defibrillator devices are deactivated in terminally ill patients. Med Sci Law. 2010;50(1):40-44. doi:https://doi.org/10.1258/msl.2009.009006
10.
MorgenweckCJ. Ethical considerations for discontinuing pacemakers and automatic implantable cardiac defibrillators at the end-of-life. Curr Opin Anaesthesiol. 2013;26(2):171-175. doi:https://doi.org/10.1097/ACO.0b013e32835e8349
11.
BlockSD. Assessing and managing depression in the terminally ill patient. ACP-ASIM end-of-life care consensus panel. American College of Physicians—American Society of Internal Medicine. Ann Intern Med. 2000;132(3):209-218. doi:https://doi.org/10.7326/0003-4819-132-3-200002010-00007
12.
BraunTCHagenNAHatfieldREWyseDG. Cardiac pacemakers and implantable defibrillators in terminal care. J Pain Symptom Manage. 1999;18(2):126-131. doi:https://doi.org/10.1016/S0885-3924(99)00038-X
13.
MuellerPSOttenbergALHayesDLKoenigBA. I felt like the angel of death”: role conflicts and moral distress among allied professionals employed by the US cardiovascular implantable electronic device industry. J Interv Card Electrophysiol. 2011;32(3):253-261. doi:https://doi.org/10.1007/s10840-011-9607-8
14.
BuchhalterLCOttenbergALWebsterTLSwetzKMHayesDLMuellerPS. Features and outcomes of patients who underwent cardiac device deactivation. JAMA Intern Med. 2014;174(1):80-85. doi:https://doi.org/10.1001/jamainternmed.2013.11564
15.
LampertRHayesDLAnnasGJ, et al.American College of Cardiology, American Geriatrics Society, American Academy of Hospice and Palliative Medicine, American Heart Association, European Heart Rhythm Association, Hospice and Palliative Nurses Association. HRS expert consensus statement on the management of cardiovascular implantable electronic devices (CIEDs) in patients nearing end of life or requesting withdrawal of therapy. Heart Rhythm. 2010;7(7):1008-1026.
16.
PasalicDTajouriTHOttenbergALMuellerPS. The prevalence and contents of advance directives in patients with pacemakers. Pacing Clin Electrophysiol. 2013;37(4):473-480. doi:https://doi.org/10.1111/pace.12287
17.
KellyBMcClementSChochinovHM. Measurement of psychological distress in palliative care. Palliat Med. 2006;20(8):779-789. doi:https://doi.org/10.1177/0269216306072347
18.
AntunesBMurtaghFBauseweinCHardingRHigginsonIJ. Screening for depression in advanced disease: psychometric properties, sensitivity, and specificity of two items of the Palliative Care Outcome Scale (POS). J Pain Symptom Manage. 2015;49(2):277-288. doi:https://doi.org/10.1016/j.jpainsymman.2014.06.014
