Four Seasons, Flat Rock, North Carolina 28731, USA.
J Palliat Med. 2011 Oct;14(10):1184-8. doi: 10.1089/jpm.2011.0084. Epub 2011 Sep 1.
Although there has been considerable controversy regarding the deactivation of pacemakers near the end of life, clinicians can expect to face more requests for pacemaker withdrawal as the number of implants grows. Despite a clear ethical and legal precedent, these requests may elicit significant psychological and moral distress on the part of the clinical team. We illustrate some of the difficulties clinicians may face by describing the case of a patient with end-stage heart failure who asked to have her pacemaker turned off near the end of life. We discuss the challenges in determining pacemaker dependency, differing attitudes toward deactivating pacemakers versus other cardiac devices, and how the issues of perceived burden and timing of death may contribute to a clinician's sense of moral distress.
尽管在生命末期停用起搏器存在相当大的争议，但随着植入数量的增加，临床医生可能会面临更多要求取出起搏器的情况。尽管有明确的伦理和法律先例，但这些请求可能会引起临床团队的重大心理和道德困扰。我们通过描述一位患有终末期心力衰竭的患者在生命末期要求关闭起搏器的案例来说明临床医生可能面临的一些困难。我们讨论了确定起搏器依赖性的挑战，以及对停用起搏器与其他心脏设备的不同态度，以及感知负担和死亡时间等问题如何导致临床医生的道德困扰。
