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CAPC Palliative Care Discussion Forum
General Operational Topics
Policy on deactivating of Pacer Makers and ID'sDate: Dec 18, 2007 5:05 pm
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| 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
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| 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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