Hebrew SeniorLife Institute for Aging Research, Boston, MA, USA.
Prog Cardiovasc Dis. 2012 Nov-Dec;55(3):290-9. doi: 10.1016/j.pcad.2012.09.003.
Cardiac implantable electrical devices (CIEDs), including pacemakers (PMs) and implantable cardioverter-defibrillators (ICDs), are the most effective treatment for life-threatening arrhythmias. Patients or their surrogates may request device deactivation to avoid prolongation of the dying process or in other settings, such as after device-related complications or with changes in health care goals. Despite published guidelines outlining theoretical and practical aspects of this common clinical scenario, significant uncertainty remains for both patients and health care providers regarding the ethical and legal status of CIED deactivation. This review outlines the ethical and legal principles supporting CIED deactivation, centered upon patient autonomy and authority over their own medical treatment. The empirical literature describing stakeholder views and experiences surrounding CIED deactivation is described, along with implications of these studies for future research surrounding the care of patients with CIEDs.
心脏植入式电子设备（CIEDs），包括起搏器（PMs）和植入式心律转复除颤器（ICDs），是治疗危及生命的心律失常最有效的方法。患者或其代理人可能会要求停用设备，以避免延长死亡过程，或在其他情况下，如在与设备相关的并发症后，或在医疗保健目标发生变化后。尽管有发表的指南概述了这一常见临床情况的理论和实践方面，但患者和医疗保健提供者在 CIED 停用的伦理和法律地位方面仍存在很大的不确定性。这篇综述概述了支持 CIED 停用的伦理和法律原则，以患者自主权和对自己医疗的权威为中心。描述了描述围绕 CIED 停用的利益相关者观点和经验的实证文献，以及这些研究对围绕 CIED 患者护理的未来研究的影响。
