Coping With End of Life Pain

Removing implantable defibrillators to alleviate end of life pain

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) There may be a lot of discussion about activating implantable defibrillators that aid patients with life-threatening heart arrhythmias. But there is still little talk about deactivating them in the terminally ill.

Patients and doctors may need more information about deactivating implantable defibrillators to prevent needless pain among terminally ill patients.

"Ask your doctor if defibrillator deactivation is appropriate."

James E. Russo, a nurse practitioner who is coordinator of the Pacemaker Clinic at the Department of Veterans Affairs Medical Center, said that though implantable defibrillators can be deactivated so that terminally ill patients can experience a more peaceful death, there are no formal protocols to address the scenario.

Implantable defibrillators deliver a high-energy electrical shock to restore normal heart rhythms in patients with heart arrhythmias. In terminally ill patients, their deaths can be unnecessarily painful if the device delivers shocks while they are dying.

Researchers reviewed 14 published journal articles about implantable defibrillator deactivation published between 1999 and 2010 for the review study. They found that that a lack of knowledge among physicians and medical providers about defibrillator deactivation in terminally ill patients could adversely affect the timing of discussions regarding deactivation. The study also revealed that doctors' reluctance to discuss deactivation may in part stem from personal discomfort and lack of experience.

It was also revealed that deactivation is most often performed by an industry representative instead of a patient's doctor, which results in a loss of continuity of care. A lack of patient knowledge also affects their ability to make informed decisions about deactivation, investigators discovered.

Researchers found that discussions about deactivation were most likely to occur when there is a formal institutional policy, and that deactivation is more likely when it is talked about as part of an interdisciplinary approach to care.

The review was published in the October issue of the American Journal of Nursing.

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Review Date: 
October 4, 2011
Last Updated:
October 4, 2011