A Decision Deferred: Turning Off the Pacemaker

 

Many adult siblings are having a difficult time as they face their parents’ aging and related deci­sions regarding caregiving, healthcare, property distribution, estate planning, and more.  One medical reality that few people are facing up to is what to do with their cardiac devices.

Nobody really knows exactly how many Americans are walking around with pacemakers and defibrillators. But with surgeons implanting at least 225,000 pacemakers and 133,000 defibrillators each year, “there probably are a couple of million” out there now, said Dr. Paul S. Mueller, a Mayo Clinic general internist and bioethicist.

The devices prolong lives, but “all those people will face decisions down the road,” Dr. Mueller said. “’Do I keep it going? Do I turn it off?’” Physicians have similar questions, including what kinds of patients confront these choices and who usually winds up making these decisions.

Paula Span, in this excellent article from The New York Times, writes that we know a bit more now that Dr. Mueller and his colleagues have reviewed the medical records of 150 Mayo Clinic patients who, over four years, requested that their devices be deactivated — the largest group of such patients examined to date. What the data show is that these patients are mostly male, quite old, very sick — and unprepared to deal with this issue. 

“These patients typically are very ill. They’re approaching death,” said Dr. Mueller. Two-thirds were men; their median age was 79. In the years since they received their devices, many had developed other problems in addition to heart disease, including cancer and respiratory and neurological diseases.

Yet the majority hadn’t recorded their desire to deactivate their cardiac devices. More than half — a comparatively high proportion — had done what health care providers perennially urge and had prepared advance directives, but only one of those documents made any mention of cardiac technology.

“The consequence is, a huge number of surrogates had to make these decisions,” Dr. Matlock said in an interview, pointing out that about half of the requests for deactivation in the study came from surrogates. “Nobody wants that. People’s big concern at the end of life is not to burden their families.”

If you or someone you know could benefit from structured assistance in family decision making, contact Falmouth Mediation at 508-566-4159508-566-4159 for a free, no-obligation, private, confidential consultation. We will be happy to discuss the key details of your situation, address any concerns and help you decide if elder me­diation would be beneficial.

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