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Clinical Trial
. 2010 Nov;7(11):1537-42.
doi: 10.1016/j.hrthm.2010.07.018. Epub 2010 Jul 19.

Ethical and legal views of physicians regarding deactivation of cardiac implantable electrical devices: a quantitative assessment

Daniel B Kramer  1 , Aaron S Kesselheim, Dan W Brock, William H Maisel
Affiliations
Clinical Trial

Ethical and legal views of physicians regarding deactivation of cardiac implantable electrical devices: a quantitative assessment

Daniel B Kramer et al. Heart Rhythm. 2010 Nov.

Abstract

Background: Despite the high prevalence of pacemakers and implantable cardioverter-defibrillators, little is known about physicians' views surrounding the ethical and legal aspects of managing these devices at the end of life.

Objective: The purpose of this study was to identify physicians' experiences and views surrounding the ethical and legal aspects of managing cardiac devices at the end of life.

Methods: Survey questions were administered to internal medicine physicians and subspecialists at a tertiary care center. Physicians were surveyed about their clinical experience, legal knowledge, and ethical beliefs relating to the withdrawal of PM and ICD therapy in comparison to other life-sustaining therapies.

Results: Responses were obtained from 185 physicians. Compared to withdrawal of PMs and ICDs, physicians more often reported having participated in the withdrawal or removal of mechanical ventilation (86.1% vs 33.9%, P <.0001), dialysis (60.6% vs 33.9%, P <.001), and feeding tubes (73.8% vs 33.9%, P <.0001). Physicians were consistently less comfortable discussing cessation of PMs and ICDs compared to other life-sustaining therapies (P <.005). Only 65% of physicians correctly identified the legal status of euthanasia in the United States, and 20% accurately reported the legal status of physician-assisted suicide in the United States. Compared to deactivation of an ICD, physicians more often characterized deactivation of a PM in a pacemaker-dependent patient as physician-assisted suicide (19% vs 10%, P = .027) or euthanasia (9% vs 1%, P <.001).

Conclusion: In this single-center study, internists were less comfortable discussing cessation of PM and ICD therapy compared to other life-sustaining therapies and lacked experience with this practice. Education regarding the legal and ethical parameters of device deactivation is needed.

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Figures

Figure 1
Figure 1. Definitions provided to study participants
FIGURE 2
FIGURE 2. PHYSICIANS' LACK OF COMFORT DISCUSSING WITHDRAWAL OF SPECIFIC LIFE-SUSTAINING THERAPIES*
*P<0.005 for comparison of mechanical ventilation, feeding tubes, and dialysis vs. each of three cardiac device options.
FIGURE 3
FIGURE 3. PHYSICIANS' VIEWS ON PACEMAKER AND IMPLANTABLE DEFIBRILLATOR DEACTIVATION COMPARED TO WITHDRAWAL OF OTHER THERAPIES
The percentage of physicians who viewed withdrawal of PM (RED-HATCHED bars) or ICD (BLUE-SOLID bars) therapy to be morally different compared to withdrawal of each therapy additional therapy are shown. *P<0.001 for ICD vs. PM for mechanical ventilation, dialysis P=0.016 for ICD vs. PM for feeding tube P=NS for ICD vs. PM for chest compressions
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References

    1. Lampert R, Hayes DL, Annas GJ, et al. HRS Expert Consensus Statement on the Management of Cardiovascular Implantable Electronic Devices (CIEDs) in patients nearing end of life or requesting withdrawal of therapy This document was developed in collaboration with the American College of Cardiology (ACC), the American Geriatrics Society (AGS), the American Academy of Hospice and Palliative Medicine (AAHPM); the American Heart Association (AHA), and the European Heart Rhythm Association (EHRA) Heart Rhythm. 2010 May 13;
    1. Sulmasy DP, Sood JR, Ury WA. Physicians' confidence in discussing do not resuscitate orders with patients and surrogates. J Med Ethics. 2008 Feb;34(2):96–101. - PubMed
    1. Perry E, Swartz R, Smith-Wheelock L, Westbrook J, Buck C. Why is it difficult for staff to discuss advance directives with chronic dialysis patients? J Am Soc Nephrol. 1996 Oct;7(10):2160–8. - PubMed
    1. Holley JL, Foulks CJ, Moss AH. Nephrologists' reported attitudes about factors influencing recommendations to initiate or withdraw dialysis. J Am Soc Nephrol. 1991 Jun;1(12):1284–8. - PubMed
    1. Farber NJ, Simpson P, Salam T, et al. Physicians' decisions to withhold and withdraw life-sustaining treatment. Arch Intern Med. 2006 Mar 13;166(5):560–4. - PubMed

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