Ethical considerations for turning off pacemakers and defibrillators

Area of Science:

• Medical Ethics
• Cardiology
• Geriatrics

Background:

• Cardiovascular implantable electronic devices (CIEDs) are increasingly common.
• End-of-life care discussions for CIEDs remain challenging for clinicians and patients.
• Existing guidelines support honoring patient requests for CIED deactivation.

Purpose of the Study:

• To explore the ethical permissibility of deactivating CIEDs at the end of life.
• To address clinician and patient discomfort surrounding CIED deactivation.
• To provide guidance for managing CIEDs in end-of-life care.

Main Methods:

• Ethical analysis based on established principles.
• Review of 2010 guidelines on CIED management.
• Discussion of clinical scenarios and patient values.

Main Results:

• Deactivating CIEDs at end-of-life is morally permissible when aligned with patient wishes.
• Discomfort with deactivation stems from complex ethical and emotional factors.
• Proactive discussion and patient-centered values are crucial.

Conclusions:

• Honoring patient autonomy in end-of-life CIED deactivation is ethically sound.
• Clinicians should initiate conversations about CIED deactivation early and revisit them as needed.
• Respecting patient values ensures ethical and compassionate end-of-life care.