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Published on: February 28, 2012
End-of-life and other ethical issues related to pacemaker and defibrillator use in the elderly
1University of South Florida, Tampa, FL, USA. llbasta@yahoo.com
Insights
The implantation of pacemakers and cardioverter-defibrillators in elderly patients with cardiac impairment is increasing. Physicians need better training to help patients make informed decisions about end-of-life care involving complex technologies.
Area of Science:
- Cardiology
- Medical Ethics
- Geriatrics
Background:
- Increasing rates of pacemaker and cardioverter-defibrillator implantation in elderly patients with cardiac impairment.
- End-of-life interventions become more complex, costly, and less effective as patients near death.
Purpose of the Study:
- To examine the complexities of informed consent for end-of-life cardiac interventions in the elderly.
- To highlight the challenges physicians face in advising patients on sophisticated treatments versus palliative care.
Main Methods:
- Review of current practices and ethical considerations in end-of-life cardiac device implantation.
- Analysis of physician training inadequacies regarding complex end-of-life decision-making.
Main Results:
- Informed consent for end-of-life treatments is challenging due to complexity, cost, and reduced effectiveness.
- Few patients or families can make fully informed decisions about advanced cardiac technologies at the end of life.
- Physician training inadequately prepares them for end-of-life counseling in a high-technology context.
Conclusions:
- Physicians require enhanced training and resources to effectively guide patients through end-of-life decisions involving cardiac devices.
- Professional societies should develop programs to support physicians in treating dying patients amidst technological advancements.
- Addressing the gap in physician preparedness is crucial for improving end-of-life care and informed consent in cardiology.
Abstract:
In the past decade, the rate of implantation of pacemakers and cardioverter-defibrillators in the elderly with cardiac impairment has soared. As patients near the end of life, interventions become more complicated and expensive, and less effective. In this context, "informed consent" requires consideration of issues different from those faced in more routine settings. Informed consent requires full disclosure, patient competence, and free exercise of will-but in practice, few patients or their families are in a position to make fully informed decisions about highly complex treatments at the end of life. Physicians continue to bear the responsibility of advising patients about sophisticated interventions or, alternatively, palliative care. Physician training, with its narrow focus on the treatment of disease with drugs and technology, has not prepared physicians to advise patients on issues arising from the availability of multiple interventions at the end of life. Professional societies can fill a gap by developing programs and materials to help physicians treat their dying patients in a high-technology era.
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