Bioethical considerations and the lack of guidelines complicate the comanagement of do-not-resuscitate orders and the deactivation of implantable cardioverter defibrillators near the end of life.
This paper highlights the ethical complexities and need for guidelines regarding the deactivation of implantable cardioverter defibrillators in patients nearing the end of life.
Implantable cardioverter defibrillators are life-saving devices for many patients with cardiac disease. Recipients of these devices, nevertheless, often suffer from progressive comorbid and cardiac conditions. Therefore, physicians should anticipate situations in which the defibrillator is no longer desired by the patient or no longer medically appropriate. Near the end of life, many of these patients may decline cardiopulmonary resuscitation. The comanagement of do-not-resuscitate orders and implanted defibrillators can be confusing to patients and physicians alike since the former proscribe the use of electrical cardioversion while the latter provide this precise treatment. Although the use of implanted defibrillators has important ethical implications, few studies have examined these issues, and guidelines have not yet been developed to assist physicians in caring for patients who have received defibrillators. This paper discusses bioethical considerations in disabling implantable cardioverter defibrillators.
Jeffrey T. Berger (Tue,) conducted a review in Cardiac disease with implantable cardioverter defibrillators. Deactivating Implanted Cardioverter Defibrillators was evaluated. Bioethical considerations and the lack of guidelines complicate the comanagement of do-not-resuscitate orders and the deactivation of implantable cardioverter defibrillators near the end of life.
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