Is Pacemaker Deactivation at the End of Life Unique?: A Case Study and Ethical Analysis

Abstract

Although there has been considerable controversy regarding the deactivation of pacemakers near the end of life, clinicians can expect to face more requests for pacemaker withdrawal as the number of implants grows. Despite a clear ethical and legal precedent, these requests may elicit significant psychological and moral distress on the part of the clinical team. We illustrate some of the difficulties clinicians may face by describing the case of a patient with end-stage heart failure who asked to have her pacemaker turned off near the end of life. We discuss the challenges in determining pacemaker dependency, differing attitudes toward deactivating pacemakers versus other cardiac devices, and how the issues of perceived burden and timing of death may contribute to a clinician's sense of moral distress.

Grey area nursing: high-dependency nurses’ experiences of caring for patients approaching the transition from curative to palliative care

“…Similar challenges have been reported in studies investigating withdrawal of dialysis for people with end-stage renal failure (Song et al, 2015;Lazenby et al, 2016), as well as within the heart failure arena (Whitlock et al, 2011).…”