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ACADEMIA AND CLINIC

The Ethics of Deactivating Implanted Cardioverter Defibrillators

Jeffrey T. Berger, MD

19 April 2005 | Volume 142 Issue 8 | Pages 631-634

Implantable cardioverter defibrillators are life-saving devices for many patients with cardiac disease. Recipients of these devices, nevertheless, often suffer from progressive comorbid and cardiac conditions. Therefore, physicians should anticipate situations in which the defibrillator is no longer desired by the patient or no longer medically appropriate. Near the end of life, many of these patients may decline cardiopulmonary resuscitation. The comanagement of do-not-resuscitate orders and implanted defibrillators can be confusing to patients and physicians alike since the former proscribe the use of electrical cardioversion while the latter provide this precise treatment. Although the use of implanted defibrillators has important ethical implications, few studies have examined these issues, and guidelines have not yet been developed to assist physicians in caring for patients who have received defibrillators. This paper discusses bioethical considerations in disabling implantable cardioverter defibrillators.

Author and Article Information

From State University of New York Stony Brook School of Medicine, Stony Brook, New York, and Winthrop University Hospital, Mineola, New York.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Jeffrey T. Berger, MD, Clinical Ethics, Department of Medicine, Winthrop University Hospital, 222 Station Plaza North, Suite 518, Mineola, NY 11501; e-mail, jberger{at}winthrop.org.

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