Study examines health providers' perspectives on ICD deactivation in end-of-life situations

March 12, 2013

In the United States alone, an estimated 100,000 patients per year receive implantable cardioverter defibrillators (ICDs) – devices that detect life-threatening heart rhythm irregularities and deliver a high-voltage shock to return the heart to a normal pace. Despite their lifesaving purpose, many patients and clinicians will ultimately be faced with difficult decisions about deactivation of these devices as patients age and develop other conditions that may prove terminal. Little is understood about physicians' views surrounding the ethical aspects of ICD deactivation in end-of-life situations, especially as it relates to other medical interventions and patient and family directives.

Now, new research from the Perelman School of Medicine at the University of Pennsylvania has revealed that many electrophysiology practitioners believe ICD and pacemaker deactivation to be ethically distinct and that an ICD should not be deactivated without discussion with patients and families, even in the face of medical futility. The study results were reported today at the 2013 American College of Cardiology meeting in San Francisco (Abstract # 1277-28).

"Decisions by medical providers not to resuscitate patients, despite patient and/or family wishes to the contrary, are extremely controversial. However, they have been argued to be ethically justified in cases of medical futility and may be gaining traction in an era of cost-consciousness, concern over ICU beds as a scarce resource, spiraling costs of care at the end of patient's lives, and frustrations on the part of medical providers over the provision of futile care," said senior study author James N. Kirkpatrick, MD, assistant professor in the Division and the Department of and Health Policy at Penn. "In general, medical providers are not expected to provide care they believe is futile. Most and providers see no ethical distinction between defibrillation by an ICD and external defibrillation in the performance of CPR. In this study, we sought to explore ethical beliefs of clinicians regarding deactivation of ICDs in end-of-life situations, including deactivation against patient and family/surrogate wishes, known as unilateral deactivation."

To better understand practitioners' viewpoints, the research team polled 383 electrophysiology providers (including doctors, nurses, technicians) to gain insights into the ethical considerations involved in deactivation. Seventy-seven percent of respondents indicated that an ICD should not be unilaterally deactivated, whether against the wishes of a patient or against the wishes of the family/surrogate, even in the face of medical futility.

They also found that 43 percent of respondents believe that ICDs were not like any other medical intervention, including external defibrillation, dialysis, and coronary stents. In regards to other life-sustaining interventions, 73 percent of respondents indicated that deactivating an ICD was not ethically/morally different than not performing CPR; however, 83 percent of respondents indicated that deactivating a pacemaker was ethically/morally different than deactivating the shocking function of an ICD.

"In our study, there was a mixed response regarding the ethical nature of ICDs and the justification for deactivating them in end-of-life situations, but most of the sample did not believe ICDs fit into any of our currently accepted categories for types of therapies we withdraw, such as mechanical ventilation," said Dr. Kirkpatrick. "Based on these findings, we need to further explore ways to help clinicians address end-of-life management of ICDs."

Explore further: Cardiologists suggest patient-centered approach to replacing implantable cardioverter-defibrillators

Related Stories

Cardiologists suggest patient-centered approach to replacing implantable cardioverter-defibrillators

January 25, 2012
More than 100,000 implantable cardioverter-defibrillators (ICDs) are implanted in the United States annually, fully a quarter of those are generator replacements simply because the battery is depleted. But are all those replacements ...

Education, psychological support key for defibrillator patients

September 24, 2012
Improved patient education and ongoing psychological support will help people cope with the psychological distress of having an implanted defibrillator, according to a scientific statement from the American Heart Association.

Implanted defibrillator patients prefer device off if very ill, survey finds

January 30, 2013
(HealthDay)—Most heart patients with implantable cardioverter-defibrillators (ICDs) would prefer to switch off the device if they had an advanced illness, new research suggests.

Recommended for you

Female researchers pay more attention to sex and gender in medicine

November 7, 2017
When women participate in a medical research paper, that research is more likely to take into account the differences between the way men and women react to diseases and treatments, according to a new study by Stanford researchers.

Drug therapy from lethal bacteria could reduce kidney transplant rejection

August 3, 2017
An experimental treatment derived from a potentially deadly microorganism may provide lifesaving help for kidney transplant patients, according to an international study led by investigators at Cedars-Sinai.

Exploring the potential of human echolocation

June 25, 2017
People who are visually impaired will often use a cane to feel out their surroundings. With training and practice, people can learn to use the pitch, loudness and timbre of echoes from the cane or other sounds to navigate ...

Team eradicates hepatitis C in 10 patients following lifesaving transplants from infected donors

April 30, 2017
Ten patients at Penn Medicine have been cured of the Hepatitis C virus (HCV) following lifesaving kidney transplants from deceased donors who were infected with the disease. The findings point to new strategies for increasing ...

'bench to bedside to bench': Scientists call for closer basic-clinical collaborations

March 24, 2017
In the era of genome sequencing, it's time to update the old "bench-to-bedside" shorthand for how basic research discoveries inform clinical practice, researchers from The Jackson Laboratory (JAX), National Human Genome Research ...

The ethics of tracking athletes' biometric data

January 18, 2017
(Medical Xpress)—Whether it is a FitBit or a heart rate monitor, biometric technologies have become household devices. Professional sports leagues use some of the most technologically advanced biodata tracking systems to ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.