CardioVascular Institute, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts 02446, USA.
Heart Rhythm. 2010 Nov;7(11):1537-42. doi: 10.1016/j.hrthm.2010.07.018. Epub 2010 Jul 19.
Despite the high prevalence of pacemakers and implantable cardioverter-defibrillators, little is known about physicians' views surrounding the ethical and legal aspects of managing these devices at the end of life.
The purpose of this study was to identify physicians' experiences and views surrounding the ethical and legal aspects of managing cardiac devices at the end of life.
Survey questions were administered to internal medicine physicians and subspecialists at a tertiary care center. Physicians were surveyed about their clinical experience, legal knowledge, and ethical beliefs relating to the withdrawal of PM and ICD therapy in comparison to other life-sustaining therapies.
Responses were obtained from 185 physicians. Compared to withdrawal of PMs and ICDs, physicians more often reported having participated in the withdrawal or removal of mechanical ventilation (86.1% vs 33.9%, P <.0001), dialysis (60.6% vs 33.9%, P <.001), and feeding tubes (73.8% vs 33.9%, P <.0001). Physicians were consistently less comfortable discussing cessation of PMs and ICDs compared to other life-sustaining therapies (P <.005). Only 65% of physicians correctly identified the legal status of euthanasia in the United States, and 20% accurately reported the legal status of physician-assisted suicide in the United States. Compared to deactivation of an ICD, physicians more often characterized deactivation of a PM in a pacemaker-dependent patient as physician-assisted suicide (19% vs 10%, P = .027) or euthanasia (9% vs 1%, P <.001).
In this single-center study, internists were less comfortable discussing cessation of PM and ICD therapy compared to other life-sustaining therapies and lacked experience with this practice. Education regarding the legal and ethical parameters of device deactivation is needed.
尽管心脏起搏器和植入式心律转复除颤器的应用非常普遍，但对于医生在生命末期管理这些设备时所涉及的伦理和法律问题的看法，我们知之甚少。
本研究旨在了解医生在生命末期管理心脏设备时所涉及的伦理和法律问题方面的经验和看法。
在一家三级医疗中心，我们向内科医生和亚专科医生发放了调查问题。医生们被调查了有关其在与其他维持生命的治疗方法相比，停止心脏起搏器和植入式心律转复除颤器治疗的临床经验、法律知识和伦理信念。
我们收到了 185 名医生的回复。与停止心脏起搏器和植入式心律转复除颤器相比，医生更经常报告参与了停止或移除机械通气（86.1% 与 33.9%，P<.0001）、透析（60.6%与 33.9%，P<.001）和喂养管（73.8%与 33.9%，P<.0001）的治疗。与其他维持生命的治疗方法相比，医生在讨论停止心脏起搏器和植入式心律转复除颤器的治疗时始终感到不太自在（P<.005）。只有 65%的医生正确识别了美国安乐死的法律地位，而 20%的医生准确报告了美国协助自杀的法律地位。与 ICD 去激活相比，医生更常将依赖起搏器的患者中 PM 的去激活描述为协助自杀（19%与 10%，P=.027）或安乐死（9%与 1%，P<.001）。
在这项单中心研究中，与其他维持生命的治疗方法相比，内科医生在讨论停止心脏起搏器和植入式心律转复除颤器治疗时感到不那么自在，而且缺乏这方面的经验。需要进行有关设备停用的法律和伦理参数的教育。
