Treating or Killing? The Divergent Moral Implications of Cardiac Device Deactivation

2019 ◽  
Vol 45 (1) ◽  
pp. 28-41 ◽  
Author(s):  
Bryan C Pilkington
Keyword(s):  
Medical Ethics ◽  
Implantable Cardioverter Defibrillator ◽  
Recent Work ◽  
Cardiac Pacemaker ◽  
Cardiac Device ◽  
Cardioverter Defibrillator ◽  
Medical Technologies ◽  
Dependent Patient ◽  
Moral Difference

Abstract In this article, I argue that there is a moral difference between deactivating an implantable cardioverter defibrillator (ICD) and turning off a cardiac pacemaker (CP). It is, at least in most cases, morally permissible to deactivate an ICD. It is not, at least in most cases, morally permissible to turn off a pacemaker in a fully or significantly pacemaker-dependent patient. After describing the relevant medical technologies—pacemakers and ICDs—I continue with contrasting perspectives on the issue of deactivation from practitioners involved with these devices: physicians, nurses, and allied professionals. Next, I offer a few possible analyses of the situation, relying on recent work in medical ethics. Considerations of intention, responsibility, and replacement support my distinguishing between ICDs and CPs. I conclude by recommending a change in policy of one of the leading cardiac societies.

Heartbeats, Burdens, and Biofixtures

2021 ◽  
Vol 30 (2) ◽  
pp. 285-296
Author(s):  
KELSEY GIPE
Keyword(s):  
End Of Life ◽  
Moral Status ◽  
Cardiac Pacemaker ◽  
Ventricular Assist Devices ◽  
Ventricular Assist ◽  
Withdrawal Of Treatment ◽  
Artificial Hearts ◽  
Dependent Patient ◽  
Moral Difference ◽  
Significant Point

AbstractThis paper addresses a dichotomy in the attitudes of some clinicians and bioethicists regarding whether there is a moral difference between deactivating a cardiac pacemaker in a highly dependent patient at the end of life, as opposed to standard cases of withdrawal of treatment. Although many clinicians hold that there is a difference, some bioethicists maintain that the two sorts of cases are morally equivalent. The author explores one potential morally significant point of difference between pacemakers and certain other life-sustaining treatments: specifically, that the former are biofixtures, which become part of the patient in a way that the latter do not. The concept of the pacemaker as biofixture grants pacemakers a unique moral status that gives reason to treat a pacemaker the same as other parts of the patient that are necessary to sustain life. The author employs this biofixture analysis to affirm the intuition that deactivating a pacemaker in a highly dependent patient at the end of life is, in moral terms, more analogous to active euthanasia than it is to standard cases of withdrawal of treatment. The paper concludes with consideration of potential implications for further implantable medical technologies, such as ventricular assist devices and total artificial hearts.

scholarly journals Implantation of a VDD implantable cardioverter-defibrillator lead via a persistent left superior vena cava

2022 ◽  
Author(s):  
Mate Vamos ◽  
Laszlo Saghy ◽  
Gabor Bencsik
Keyword(s):  
Implantable Cardioverter Defibrillator ◽  
Superior Vena Cava ◽  
Superior Vena ◽  
Vena Cava ◽  
Left Superior Vena Cava ◽  
Icd Implantation ◽  
Cardiac Device ◽  
Current Case ◽  
Persistent Left Superior Vena ◽  
Cardioverter Defibrillator

AbstractA persistent left superior vena cava (LSVC) represents a challenging congenital abnormality for transvenous cardiac device implantation. In the current case a secondary prophylactic VDD implantable cardioverter-defibrillator (ICD) implantation was planned in a 75-year-old woman presenting with ischemic cardiomyopathy and elevated stroke risk. Since no venous communication to the right side was identified intraoperatively, the lead was placed via the persistent LSVC. The far-field signal on the floating atrial dipole could be successfully blanked out, and appropriate device function with high and stable atrial sensing was demonstrated at follow-up.

scholarly journals A Young Man Presenting with Pleuritic Chest Pain and Fever after Electrophysiological Study and Implantable Cardioverter-Defibrillator Placement: Diagnostic Difficulties and Value of Bedside Thoracic Sonography

2015 ◽  
Vol 2015 ◽  
pp. 1-4
Author(s):  
Antonio Faraone ◽  
Alberto Fortini
Keyword(s):  
Pulmonary Embolism ◽  
Chest Pain ◽  
Implantable Cardioverter Defibrillator ◽  
Point Of Care ◽  
Present Report ◽  
Electrophysiological Study ◽  
Pleuritic Chest Pain ◽  
Cardiac Device ◽  
Cardioverter Defibrillator ◽  
Prolonged Fever

We describe the case of a 23-year-old man presenting with recurrent pleuritic chest pain and prolonged fever after electrophysiology testing and placement of an implantable cardioverter-defibrillator because of a suspected arrhythmogenic right ventricular dysplasia. The clinical suspicion was initially directed toward pneumonia with pleural effusion and later toward an infection of the cardiac device complicated by septic pulmonary embolism. The definitive diagnosis of pulmonary embolism and infarction was suggested by a point-of-care thoracic sonography, performed at the bedside by a clinician caring for the patient, and then confirmed by contrast enhanced computed tomography, which also showed thrombosis of the left iliofemoral vein, site of percutaneous puncture for cardiac catheterization. Prolonged fever was attributable to a concomitant Epstein-Barr virus primary infection that acted as confounding factor. The present report confirms the value of bedside thoracic sonography in the diagnostic evaluation of patients with nonspecific respiratory symptoms.

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