Pacemaker deactivation: withdrawal of support or active ending of life?

Theoretical Medicine and Bioethics
Thomas S Huddle, F Amos Bailey

Abstract

In spite of ethical analyses assimilating the palliative deactivation of pacemakers to commonly accepted withdrawings of life-sustaining therapy, many clinicians remain ethically uncomfortable with pacemaker deactivation at the end of life. Various reasons have been posited for this discomfort. Some cardiologists have suggested that reluctance to deactivate pacemakers may stem from a sense that the pacemaker has become part of the patient's "self." The authors suggest that Daniel Sulmasy is correct to contend that any such identification of the pacemaker is misguided. The authors argue that clinicians uncomfortable with pacemaker deactivation are nevertheless correct to see it as incompatible with the traditional medical ethics of withdrawal of support. Traditional medical ethics is presently taken by many to sanction pacemaker deactivation when such deactivation honors the patient's right to refuse treatment. The authors suggest that the right to refuse treatment applies to treatments involving ongoing physician agency. This right cannot underwrite patient demands that physicians reverse the effects of treatments previously administered, in which ongoing physician agency is no longer implicated. The permanently indwelling pace...Continue Reading

References

Jan 1, 1993·American Journal of Public Health·M Z SolomonS Donnelley
Mar 25, 1999·Archives of Internal Medicine·D P Sulmasy, E D Pellegrino
Sep 15, 1991·Annals of Internal Medicine·UNKNOWN American Thoracic Society
May 17, 2003·Death Studies·Katrina A Bramstedt
Apr 24, 2008·Critical Care Medicine·Robert D TruogUNKNOWN American Academy of Critical Care Medicine
Apr 29, 2008·Pacing and Clinical Electrophysiology : PACE·Paul S MuellerDavid L Hayes
Jul 15, 2009·Bioethics·Franklin G MillerDan W Brock
May 18, 2010·Heart Rhythm : the Official Journal of the Heart Rhythm Society·Rachel LampertUNKNOWN Hospice and Palliative Nurses Association

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Citations

Nov 13, 2013·Pacing and Clinical Electrophysiology : PACE·Dario PasalicPaul S Mueller
Feb 17, 2015·Pacing and Clinical Electrophysiology : PACE·Margaret DaeschlerJames N Kirkpatrick
Jul 2, 2016·The American Journal of Bioethics : AJOB·John D Lantos
Apr 8, 2017·Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology·Katrina Hutchison, Robert Sparrow

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