Kay G Neal, Pelosi Frank
University of Alabama at Birmingham, Birmingham, Alabama, USA.
Division of Cardiovascular Medicine, Cardiac Electrophysiology Section, University of Michigan Health System, Ann Arbor, Michigan, USA.
Linacre Q. 2013 Nov;80(4):308-316. doi: 10.1179/2050854913Y.0000000005. Epub 2013 Nov 1.
Patients with cardiovascular implantable electronic devices (CIEDs), which include pacemakers and implantable cardioverter-defibrillators (ICDs), may request deactivation of their devices as they approach the end of life. The Heart Rhythm Society (2010) has stated that "ethically, and legally, there are no differences between refusing CIED therapy and requesting withdrawal of CIED therapy." On the basis of the principle that there is no ethical distinction between withholding and withdrawing treatment, this professional organization has suggested that both the antibradycardia and antitachycardia features of these devices may be disabled at the patient's request. We argue that disabling ICD shocks is analogs to a do-not-resuscitate order and is ethically permissible whereas withdrawing pacing from a pacemaker-dependent patient is an act of intentionally hastening death and not morally licit.
患有心血管植入式电子设备（CIEDs，包括起搏器和植入式心律转复除颤器[ICDs]）的患者在临近生命末期时可能会要求停用其设备。心律协会（2010年）指出，“在伦理和法律上，拒绝CIED治疗与要求撤销CIED治疗并无区别。”基于在停止和撤销治疗之间不存在伦理区别这一原则，该专业组织建议，应患者要求，这些设备的抗心动过缓及抗心动过速功能均可停用。我们认为，停用ICD电击类似于“不要复苏”医嘱，在伦理上是允许的，而对于依赖起搏器的患者撤销起搏则是故意加速死亡的行为，在道德上是不合法的。
