When Is Deactivating an Implanted Cardiac Device Physician-Assisted Death? Appraisal of the Lethal Pathophysiology and Mode of Death

Rady, Mohamed Y.; Verheijde, Joseph L.

doi:10.1089/jpm.2011.0161

Cited by 12 publications

(7 citation statements)

References 10 publications

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“…19 There is disagreement within the medical community with respect to deactivation. 20 Rady et al consider such an act either patient-assisted suicide or euthanasia. 20 The American Heart Rhythm Society clearly affirms that "carrying out a request to withdraw life-sustaining treatment is neither physician-assisted suicide (PAS) nor euthanasia" and that "the right to refuse or request the withdrawal of a treatment is a personal right of the patient and does not depend on the type of the treatment."…”

Section: Deactivation Of Cardiac Devicesmentioning

confidence: 99%

“…20 Rady et al consider such an act either patient-assisted suicide or euthanasia. 20 The American Heart Rhythm Society clearly affirms that "carrying out a request to withdraw life-sustaining treatment is neither physician-assisted suicide (PAS) nor euthanasia" and that "the right to refuse or request the withdrawal of a treatment is a personal right of the patient and does not depend on the type of the treatment." Management of ICDs and Cardiac Resynchronization Therapy-Defibrillator (CRT-D) as patients near the end of their lives creates ethical dilemmas.…”

Section: Deactivation Of Cardiac Devicesmentioning

confidence: 99%

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Withdrawing or Withholding Treatment

Hassan

Ali²

2018

Int. J. Hum. Health Sci.

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Muslims believe that all healing comes from God, so they have the obligation to search out medical care and right to receive appropriate medical treatment. Islam considers disease as a natural phenomenon and a type of tribulation that expiates sin. Unfortunately many elder patients with chronic illness spend their last few weeks or months in hospitals. Life support is not required if it prolongs the agony and suffering associated with final stages of a terminal illness. The decision to withhold life support from a patient in the intensive care unit (ICU) is a modern medico-legal issue. When considering end-of-life decision making, both withholding and withdrawing life support are considered to be ethically and legally equivalent. Islamic law permits withdrawal of futile treatment on the basis a clear medical decision by at least three Physicians.International Journal of Human and Health Sciences Vol. 01 No. 02 July’17. Page : 59-64

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Section: Deactivation Of Cardiac Devicesmentioning

confidence: 99%

Section: Deactivation Of Cardiac Devicesmentioning

confidence: 99%

Withdrawing or Withholding Treatment

Hassan

Ali²

2018

Int. J. Hum. Health Sci.

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“…Critics have refuted these arguments. 3,16,17,23 We have posited that ''the onset of a new lethal pathophysiology from an acute life-threatening illness (e.g., irreversible coma, circulatory shock, overwhelming infections, multiple organ failure, refractory hypoxia, or catastrophic device failure)'' differentiates allowing from assisting in a patient's death when deactivating a durable MCSD. 3 From a legal perspective, Noah concluded from the analysis of implantation procedure and device operation that ''implanted cardiac-assist devices pose serious challenges to the well-accepted equivalence between refusing and requesting the withdrawal of life-sustaining treatments'' and ''deactivation represents a distinctive form of physician aid in dying.''…”

Section: Ethical Considerations In Durable Mcsd Deactivationmentioning

confidence: 99%

Ethical Considerations in End-of-Life Deactivation of Durable Mechanical Circulatory Support Devices

RadyMohamed

VerheijdeJoseph

2013

Journal of Palliative Medicine

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“…However, confusing the terminally ill patient with the imminently dying patient does not constitute a justification for hastening death. To differentiate assisted death from natural death, we objectively defined the term ‘imminently dying’ by the onset of new lethal pathophysiology from acute life-threatening illness or fatal complications of the underlying disease 12. For instance, the onset of bronchopneumonia secondary to bulbar palsy would constitute natural death in Etkind's case.…”

Section: Assisted Dying and The Double-effect Principlementioning

confidence: 99%

Distress from voluntary refusal of food and fluids to hasten death: what is the role of continuous deep sedation?: Figure 1

Rady

Verheijde

2011

J Med Ethics

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In assisted dying, the end-of-life trajectory is shortened to relieve unbearable suffering. Unbearable suffering is defined broadly enough to include cognitive (early dementia), psychosocial or existential distress. It can include old-age afflictions that are neither life-threatening nor fatal in the "vulnerable elderly". The voluntary refusal of food and fluids (VRFF) combined with continuous deep sedation (CDS) for assisted dying is legal. Scientific understanding of awareness of internal and external nociceptive stimuli under CDS is rudimentary. CDS may blunt the wakefulness component of human consciousness without eradicating internal affective awareness of thirst and hunger. Patients may suffer because of the slow dying process following dehydration and starvation. The difficulty to adequately control distress, without bringing the dying process to a rapid conclusion by lethal pharmacological interventions, can cause feelings of guilt among hospice and medical staff. Furthermore, the double-effect principle is not applicable in these situations because the primary objective of VRFF is to hasten death. Legal and societal debate should focus on sharpening the boundaries between assisted dying and palliative care. This separation is necessary to: 1) uphold trust in the patient-phyician relationship, and 2) preserve integrity and ethics of the medical profession.

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When Is Deactivating an Implanted Cardiac Device Physician-Assisted Death? Appraisal of the Lethal Pathophysiology and Mode of Death

Cited by 12 publications

References 10 publications

Withdrawing or Withholding Treatment

Withdrawing or Withholding Treatment

Ethical Considerations in End-of-Life Deactivation of Durable Mechanical Circulatory Support Devices

Distress from voluntary refusal of food and fluids to hasten death: what is the role of continuous deep sedation?: Figure 1

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