Physicians' Preferences and Attitudes About End-of-Life Care in Patients With an Implantable Cardioverter-Defibrillator

Sherazi, Saadia; Daubert, James P.; Block, Robert C.; Jeevanantham, Vinodh; Abdel-Gadir, Khalid; Disalle, Michael R.; Haley, James M.; Shah, Abrar H.
October 2008
Mayo Clinic Proceedings;Oct2008, Vol. 83 Issue 10, p1139
Academic Journal
Clinical guidance is deficient regarding deactivation of implantable cardioverter-defibrillators (ICDs) in patients with terminal illnesses. We hypothesized that many physicians are apprehensive about discussing lCD deactivation with their dying patients. Thus, we conducted an anonymous survey of all the physicians in the Department of Medicine at Unity Health System in Rochester, NY. The survey collected information about the knowledge and preferences of these physicians regarding the medical, ethical, and legal issues involved in caring for patients with an lCD and terminal illness. Of the 204 surveys distributed, 87 (43%) were returned. Among the physicians who responded, 64 (74%) reported experience caring for a patient with an lCD and terminal illness. Forty physicians (46%) either thought it was illegal or were not sure if it was legal to deactivate an lCD in these circumstances. However, if reassured about the legality of discontinuing lCD therapy, 79 (91%) of these same respondents said that they would be willing to discuss voluntary lCD deactivation with their dying patients. With increased knowledge about managing the withdrawal of this potential;y life-prolonging therapy, physicians are likely to become more skilled at caring for dying patients with an lCD.


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