Hearts of Hospice Patients Being Needlessly Shocked

Researchers say defibrillators can be turned off on admission

By Ed Edelson
HealthDay Reporter

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THURSDAY, March 4 (HealthDay News) -- Hospices that care for people who are dying often forget to turn off their implanted defibrillators, causing unnecessary discomfort, new research has found.

Only 20 percent of more than 400 hospices that responded to a survey indicated that they had a question on their admitting form that would identify people with defibrillators, and just 10 percent said it was their policy to discuss deactivating the devices, according to a report by physicians at the Mount Sinai School of Medicine in New York City, published March 2 in the Annals of Internal Medicine. The survey found that 97 percent of the hospices, though, had admitted people with implanted defibrillators.

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A defibrillator delivers a shock to restore a normal heartbeat in people with rhythm abnormalities. "The purpose is to save a patient's life," said study author Dr. Nathan Goldstein, an assistant professor of geriatrics and palliative medicine at Mount Sinai. "There is a little burden, but mostly benefit. But there is no sense getting a shock when it is not going to fix their underlying condition."

Some hospice patients have compared the shock given by a defibrillator to being kicked or punched in the chest, Goldstein said.

He cited the case of a man who was dying of cancer and was shocked repeatedly by an implanted defibrillator. "That is very painful for the patient and upsetting for the patient and the family," Goldstein said.

A policy statement issued by the National Hospice and Palliative Care Organization said that all people with implanted defibrillators should be identified on admission to a hospice and that the option of deactivation "should be thoroughly explored with patients and their designated caregivers as soon as possible after admission."

The discussion should include an explanation that deactivation "does not constitute euthanasia nor physician-assisted suicide nor is it likely to hasten death," the statement said. If the device also acts as a pacemaker, that function can be maintained, it said.

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