Deactivating the implantable cardioverter-defibrillator: a biofixture analysis

Area of Science:

• Medical Ethics
• Biomedical Engineering
• Clinical Practice

Background:

• Increasing prevalence of automatic implantable cardioverter-defibrillators (ICDs).
• Growing trend of patients and surrogates refusing end-of-life resuscitative efforts.
• Ethical ambiguity surrounding ICD deactivation in terminally ill patients refusing cardiopulmonary resuscitation (CPR).

Purpose of the Study:

• To examine the ethical appropriateness of inferring ICD deactivation from a do-not-resuscitate (DNR) order.
• To analyze the implications of consent for DNR orders in the context of implantable devices.
• To introduce and apply the concept of "biofixtures" to ethical dilemmas involving implantable devices.

Main Methods:

• Ethical analysis of consent and decision-making for DNR orders.
• Conceptual framework development using "biofixture" analysis.
• Review of the ontologic status of implantable devices, specifically ICDs.

Main Results:

• Refusal of CPR does not automatically imply consent for ICD deactivation.
• The context and nature of consent for DNR orders are critical considerations.
• "Biofixture" analysis offers a novel approach to resolving ethical conflicts regarding implantable devices.

Conclusions:

• Physicians should not unilaterally infer ICD deactivation from a DNR order.
• Ethical care requires careful consideration of patient autonomy and device function.
• The "biofixture" concept provides a structured method for addressing complex ethical issues in patients with implantable devices.