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Next Reply: Re:Policy on deactivating of Pacer Makers and ID's
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Post Policy on deactivating of Pacer Makers and ID's
Author: carnold
Date: Dec 18, 2007 5:05 pm
Does anyone have a policy addressing deactiving pacer makers and internal defibrillators on "actively dying" patients. Guidelines for doing so and criteria that must be met before this is done. Thanks for your help.

Cheryl Arnold, RN CHPN
Palliative Care Coordinator
St. Mary's Medical Center
Evansville, IN 47750
812-485-7954
Replies: order by [Date] [Author] [Subject]
Re:Policy on deactivating of Pacer Makers and ID's (by mrabow on 12/25/2007)
Hi,

I look forward to examples of policies that others may submit. In the mean time, here are 2 links that might be helpful.

The first is a Fast Fact about pacemakers (http://www.eperc.mcw.edu/fastFact/ff_111.htm)and the second a CAPC press release about a study showing the issue is rarely discussed (http://www.capc.org/news-and-events/releases/Dec-2004-release).

The most important policy probably is that physicians and dying patients discuss the issue of deactivation.

Best,
Michael W. Rabow, MD
Associate Director
UCSF Palliative Care Leadership Center
Re:Policy on deactivating of Pacer Makers and ID's (by TerrellVanAkenMD on 05/29/2008)
I know your query has been there a while but thought I would send a first-time comment as I have just entered the forum. Dr. Mike Rabow was our excellent mentor for the PCLC at UCSF and I agree with his source of Fast Fact and Concept #111 and #112 with the Web address he noted. We have been using these policies with our palliative inpatient consult service and our hospice service. When a patient is enrolled in hospice we discuss deactivation of the ICD but typically don't worry about the pacemaker as the shocks of the ICD are more likely to promote suffering while the pacer may maintain some continued quality of life by maintaining cardiac output, etc. I always review these decisions with the treating cardiologist and PCP. Our hospice service requires a DNR status and disabling the ICD only makes sense. It's my general experience that maintaining the pacemaker doesn't prolong life beyond the natural course expected.

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