Sunday, June 20, 2010
NYT Sunday Magazine: Turning Off Pacemakers
The New York Times Sunday magazine published a must-read article for any hospice or palliative care professional. I just read it this evening after receiving a couple of tips from Pallimed readers* and don't have time to do the analysis tonight before the email goes out. Hopefully Lyle or I will likely get to covering the article in more detail later this week.
Some of the issues covered include:
- family decision to deactivate a pacemaker
- cardiologists insisting on implantation
- cardiologists refusing (on moral grounds) to deactivate a pacemaker
- getting palliative care and later hospice involved in a patient with advancing dementia
- the widower effect on mortality
- informed consent
- the distant adult child effect
- living wills
- out of hospital DNR orders and bracelets
- deciding on nursing home placement
- lack of effective professional-to-professional communication
- caregiver exhaustion
See. I told you that you must read it.
If you want to start commenting here before we do the full post later this week, feel free.
*A tip of my hat for the leads to Mary M. (via email), @hospicedoctor (Twitter), @BradHStuart (Twitter), @DianeEMeier (Twitter)
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5 Responses to “NYT Sunday Magazine: Turning Off Pacemakers”
June 21, 2010
This is a terrific article.
I was particularly dismayed that the patient initially got the pacemaker in advance of hernia surgery, a palliative measure as it was giving him pain. The surgeon refused to operate without a pacemaker being inserted due to the risk of cardiac arrest. The same surgeon told the widow she needed to be full code before valve surgery and she declined that procedure.
I understand about surgery stats and no one dying on the table, but these procedural code status decisions end up having long-term implications well beyond those surgeries.
June 23, 2010
This is the second time I have seen mention to this article today. You can't help but feel sorry for the patient.
June 24, 2010
Thanks for expediting this article - I might otherwise have missed it. I cried for this family and the many other like them. We must learn to do better.
July 21, 2010
This article underlines the malignant attitude of "cure at all costs". I have chosen to work in Hopice and Palliative care primarily because I feel strongly about having those honest and open discussions about realistic and appropriate medical interventions. I guess I am lucky to work for a Hospice agency that has a written policy for addressing pacemaker/defibrillator questions upon admission to the program. We even have a supply of magnets that are kept in patient's homes until deactivation of the device. If there is any family concerns/objections, one of our medical directors makes a home visit to facilitate a family conference. I look forward to the day when all doctors are given the time/reimbursement to have these important discussions before patients have to suffer from the "medical miracles" of our modern age.
July 24, 2010
I could not help but feel sad and at points angry at the ordeal this patient and family endured. What happened to dignity?
I come across these situations fairly often working at a large hospital where the heart transplant and LVAD services are quite aggressive. I have been called for patients who were unsure how they agreed to such a horrific ordeal.
They likely did so due to fear of death, a highly trained specialist giving the typical "spin" you have no other choice and the exclusion of the primary physician and family in the age old therapy of a family meeting! As a cancer patient I understand how we can be presented a treatment quite differently from 2 different oncologists but I have often looked them straight in the face as a physician and asked for the risks benefits alternatives.
We must find better ways to communicate and avoid tragic cases such as this. Lots of data on lack of patient preferences in medical decisions. Time for change!
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