TITLE

Perspectives on Withdrawing Pacemaker and Implantable Cardioverter-Defibrillator Therapies at End of Life: Results of a Survey of Medical and Legal Professionals and Patients

AUTHOR(S)
Kapa, Suraj; Mueller, Paul S.; Hayes, David L.; Asirvatham, Samuel J.
PUB. DATE
November 2010
SOURCE
Mayo Clinic Proceedings;Nov2010, Vol. 85 Issue 11, p981
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
OBJECTIVE: To determine the opinions of medical professionals, legal professionals, and patients regarding the withdrawal of implantable cardioverter-defibrillator (ICD) and pacemaker therapy at the end of life. PARTICIPANTS AND METHODS: A survey regarding 5 cases that focused on withdrawal of ICD or pacemaker therapy at the end of life was constructed and sent to 5270 medical professionals, legal professionals, and patients. The survey was administered from March 1, 2008, to March 1, 2009. RESULTS: Of the 5270 recipients of the survey, 658(12%) responded. in a terminally ill patient requesting that his ICD be turned off, most legal professionals (90% [63/70]), medical professionals (98% [330/336]), and patients (85% [200/236]) agreed the lCD should be turned off. Most legal professionals (89%), medical professionals (87%), and patients (79%) also considered withdrawal of pacemaker therapy In a non-pacemaker-dependent patient appropriate. However, significantly more legal (81%) than medical professionals (58%; P<.001) or patients (68%, P=.02) agreed with turning off a pacemaker in the pacemaker-dependent patient. A similar number of legal professionals thought turning off a device was legal regardless of whether it was an lCD or pacemaker (45% vs 38%; P=.50). However, medical professionals were more likely to perceive turning off an ICD as legal than turning off a pacemaker (85% vs 41%; P=.001). CONCLUSION: Most respondents thought device therapy should be withdrawn if the patient requested its withdrawal at the end of life. However, opinions of medical professionals and patients tended to be dependent on the type of device, with turning off ICOs being perceived as more acceptable than turning off pacemakers, whereas legal professionals tended to perceive all devices as similar. Thus, education and discussion regarding managing devices at the end of life are important when having end-of-life discussions and making end-of-life decisions to better understand patients' perceptions and expectations.
ACCESSION #
55414601

 

Related Articles

  • Management of Implantable Cardioverter Defibrillators in End-of-Life Care. Goldstein, Nathan E.; Lampert, Rachel; Bradley, Elizabeth; Lynn, Joanne; Krumholz, Harlan M. // Annals of Internal Medicine;12/7/2004, Vol. 141 Issue 11, p835 

    Background: Implantable cardioverter defibrillators (ICDs) can prevent premature death from an arrhythmia but may also prolong the dying process and make it more distressing. Objective: To describe the frequency, timing, and correlates of discussions about deactivating ICDs. Design:...

  • Views of relatives, carers and staff on end of life care pathways. Jackson, Ann; Purkis, Judith; Burnham, Elizabeth; Hundt, Gillian Lewando; Blaxter, Loraine // Emergency Nurse;Mar2010, Vol. 17 Issue 10, p22 

    More people die in hospital than at home (Department of Health (DH) 2008). Yet, many people do not want to die in hospital, which can be an inappropriate environment for end of life care. The government's end of life care strategy (DH 2008) and the NHS (2009) end of life care programme (EOLCP)...

  • Delivering research in end-of-life care: problems, pitfalls and future priorities. Bennett, Michael I.; Davies, Elizabeth A.; Higginson, Irene J. // Palliative Medicine;Jul2010, Vol. 24 Issue 5, p456 

    In this paper we review the challenges facing the delivery of research in end-of-life care in the UK and internationally as health policies begin to focus on improving care. These include the problems of terminology in this field of enquiry and the lack of emphasis on clinical studies relating...

  • End-of-life care conversations with heart failure patients: a systematic literature review and narrative synthesis. Barclay, Stephen; Momen, Natalie; Case-Upton, Steve; Kuhn, Ida; Smith, Elizabeth // British Journal of General Practice;Jan2011, Vol. 61 Issue 582, p59 

    The article analyzes medical literature with regards to end-of-life care (EOLC) conversations between health care professionals and patients with heart failure in Great Britain. The review of literature involves peer-reviewed journal articles between 1987 and 2010. The review of literature...

  • STATISTICS IN THE LEGAL AND MEDICAL PROFESSIONS. Croucher, John S. // International Journal of Strategic Management;2013, Vol. 13 Issue 3, p141 

    With the increasing use of complex data in the legal and medical profession it is no wonder that lawyers, judges and medical professionals are sometimes baffled by the vast array of data that passes their way. And to make matters worse, an unscrupulous "expert witness' can almost seem to make...

  • From the President of the American Arbitration Association. Coulson, Robert // Arbitration Journal;Sep84, Vol. 39 Issue 3, p2 

    The article presents the author's views on arbitration. The Supreme Court of Michigan recently decided a case upholding that state's Medical Malpractice Arbitration Act. One of the issues was whether the presence of a medical professional on the panel of arbitrators unconstitutionally created a...

  • Doctors to lawyers: We don't hate you. Rose, Joan R. // Medical Economics;8/6/2004, Vol. 81 Issue 15, p12 

    Reports on the result of the survey addressing the opinion of physicians on the law profession in the U.S. Percentage of physicians recommending law to their children; Credibility of the legal career; Impact of the increasing rate of medical malpractice litigations on the attitude toward the...

  • End-of-life care provision.  // Primary Health Care;Dec2008, Vol. 18 Issue 10, p6 

    The article presents research on the efficiency of end-of-life care provision in England and Scotland. This study explores the concerns of clinicians, user groups and commissioners. It notes that this care emerges in generalist settings. It reports that there is little consensus on what the care...

  • Preferences for end-of-life care for children with cancer. Knapp, Caprice; Komatz, Kelly // CMAJ: Canadian Medical Association Journal;11/22/2011, Vol. 183 Issue 17, pE1250 

    The authors discuss the study of D. Tomlinson and colleagues regarding end-of-life decision-making for children and pediatric palliative care. They mention that the study highlights the incongruity of the preferences of parents and health care workers, in which they consider the importance of...

Share

Read the Article

Courtesy of VIRGINIA BEACH PUBLIC LIBRARY AND SYSTEM

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics