When a person is coming to the end of life and is placed on hospice care, it is the goal of all involved to make their passing as dignified and painless as possible. For people with implantable cardioverter-defibrillators, a peaceful passing can sometimes be interrupted. These devices jolt the heart back into a normal rhythm if it starts to beat too fast or in an irregular fashion. The experience can be quite painful, and it may be worth considering deactivating the device if you or a loved one has only a short time to live.
After cancer, heart failure is the second most common diagnosis of hospice patients. Many have ICDs, which are about the size of a small cellphone and are surgically implanted under the skin, just below the collarbone.
People get admitted to hospice care because they have a short time to live (generally six months or less) and have agreed to forgo life-prolonging treatment. Hospice patients with ICDs might consider getting the devices turned off for two reasons. First, by shocking the heart, an ICD might prolong life, undermining the purpose of hospice. Second, a shock from an ICD can be quite painful (people compare it to being kicked in the chest) and upsetting. Indeed, for hospice patients, there's a good chance that the shock could cause pain or discomfort without much success in getting the heartbeat back to normal.
Turning off an ICD does not mean removing the device or any kind of surgical procedure. It's a matter of reprogramming the device electronically through the skin, an entirely painless procedure.
Deactivation isn't, by any stretch of the imagination, "pulling the plug." ICDs are there, in effect, on a standby basis in case of an arrhythmia (abnormal heart rhythm). People's hearts aren't dependent on their ICDs and will keep beating after the device is turned off.
Results of a survey of 414 American hospices published in 2010 in Annals of Internal Medicine showed that a little less than half (42 percent) of hospice patients had the shock function of their ICDs turned off, and a little more than half (58 percent) of the hospices reported that at least one of their patients had been shocked by his or her ICD in the past year.
Most ICDs are now designed to also function as pacemakers, which means they can help regulate the heartbeat if the heart starts to beat too slowly (bradycardia) or too fast (tachycardia). It's easy to turn off the shock function of the ICD and leave the pacemaker part of the device working. The pacemaker function can help control heart-related symptoms near the end of life, so pacemakers are often viewed as being compatible with the hospice goal of preventing suffering. Moreover, some people's hearts are dependent on pacemaking, so if that function were switched off, they would die soon afterward.
If an ICD hasn't been turned off and starts to fire, holding a magnet right over the device will temporarily disable it and keep it from delivering multiple shocks. The magnetic field travels through the skin and interferes with the sensors that detect arrhythmias. Even people who don't wish to have their ICDs deactivated may want to avoid multiple shocks, especially near the end of life. Some hospice programs give magnets to families who are taking care of a hospice patient with an ICD at home. Talk with your loved one's doctor when considering these options.
10%: The percentage of hospices surveyed that had a policy addressing ICD deactivation.
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