Featured Research

from universities, journals, and other organizations

Doctors' Questions About End-of-life Legalities May Result In Patient Pain

Date:
November 16, 2008
Source:
Wake Forest University Baptist Medical Center
Summary:
When treatment options dwindle or are exhausted, terminally ill-patients often opt for pain management and comfort over life-extending therapies. However, researchers report that a lack of thorough understanding about the laws governing end-of-life care may be leaving many medical providers with an ethical dilemma and causing some terminally-ill patients considerable, unnecessary pain.

When treatment options dwindle or are exhausted, terminally ill-patients often opt for pain management and comfort over life-extending therapies. However, a team of researchers from Wake Forest University Baptist Medical Center, University of Rochester Medical Center and Unity Health System, report that a lack of thorough understanding about the laws governing end-of-life care may be leaving many medical providers with an ethical dilemma and causing some terminally-ill patients considerable, unnecessary pain.

The report, appearing in a recent issue of Mayo Clinic Proceedings, concerns the legal and ethical issues involved with deactivating an implantable cardioverter-defibrillator (ICD) in patients who are terminally-ill. The ICD is a small, battery-powered electrical impulse generator, much like a pacemaker, that is implanted in patients who are at risk of sudden cardiac death due to ventricular fibrillation. The device is programmed to detect cardiac arrhythmia and correct it by delivering a jolt of electricity, which is often lifesaving. However, the legality of deactivating the ICD in terminally-ill patients who request to stop receiving the therapy is not clearly written, the study shows, and may be causing doctors to subject dying patients to undue pain.

The results stem from a physician survey that collected information about doctors' knowledge and preferences regarding the medical, ethical and legal issues involved in caring for terminally-ill patients with an ICD.

In the brief, Vinodh Jeevanantham, M.D., of Wake Forest Baptist, and colleagues identify a general lack of knowledge among physicians concerning ICD therapy in terminally-ill patients that may result in extra suffering for them.

The ICD has become the most effective treatment for patients at high risk of life-threatening ventricular arrhythmias. It has been shown to improve survival, especially in elderly patients, by sensing changes in cardiac rhythm and delivering an electrical shock to the heart to restore normal rhythm.

Terminally-ill patients may be at increased risk of ICD shocks due to electrolyte disturbances, hypoxia and heart failure. It is estimated that more than 3 million people in North America are now eligible for an ICD. With a growing elderly population in the United States, clinicians are likely to care for an increasing number of elderly patients with ICDs.

The deactivation of an ICD, which may have been placed years before the onset of a terminal condition, may not be a clear-cut decision for patients, families, or physicians. Although physicians are aware that ICDs save lives by delivering an electrical shock and that such shocks are associated with considerable pain, busy clinicians may not always re-analyze the risk-benefit ratio of ICD therapy when their patient experiences a terminal illness, the report states. In this situation, life-prolonging therapy may no longer be desired. However, although guidelines for appropriate ICD use are readily available, a glaring deficiency exists regarding end-of-life care for patients with an ICD, according to the report, and the legality of deactivation is not clearly spelled out. There are also no clear-cut recommendations, Jeevanantham said.

Although voluntary refusal of treatment is a basic patient right, the study highlights a lack of clarity regarding the laws concerning ICD therapy in terminally-ill patients.

"While 64 of the physicians who participated in our survey had cared for terminally-ill patients with an ICD, they were unaware of any guidelines regarding deactivation of the device in such patients," the authors wrote.

Of the 204 surveys distributed within Unity Health System between February and May 2007, 87 were returned. Among the physicians who responded, 64 reported experience caring for a patient with an ICD and terminal illness. Forty physicians either thought it was illegal or were not sure if it was legal to deactivate an ICD in these circumstances.

However, if the physicians were to be reassured about the legality of discontinuing ICD therapy, 79 of these same respondents said that they would be willing to discuss voluntary ICD deactivation with their dying patients. On the other hand, 16 of the physicians surveyed thought such action was either unethical or possibly unethical, and 19 physicians were uncomfortable deactivating an ICD in a terminally-ill patient, even though 51 of the doctors reported believing that an ICD-delivered shock would be painful for the patient.

"Although patients are better able to tolerate the shock from the ICD with time, they may still find an ICD firing frightening and painful," the researchers stated in their report. "Our study showed that only 51 clinicians thought that the shock therapy would be uncomfortable. This finding highlights the importance of physician education regarding the ICD functioning, particularly symptoms that result from shock therapy.

"With increased knowledge about managing the withdrawal of this potentially life-prolonging therapy, physicians are likely to become more skilled at caring for dying patients with an ICD."

Co-authors of the report were Saadia Sherazi, M.D., James P. Daubert, M.D., and Robert C. Block, M.D., all of University of Rochester Medical Center, and Khalid Abdel-Gadir, M.D., Michael R. DiSalle, M.D., James M. Haley, M.D., and Abrar H. Shah, M.D., all of Unity Health System, also in Rochester, N.Y.


Story Source:

The above story is based on materials provided by Wake Forest University Baptist Medical Center. Note: Materials may be edited for content and length.


Cite This Page:

Wake Forest University Baptist Medical Center. "Doctors' Questions About End-of-life Legalities May Result In Patient Pain." ScienceDaily. ScienceDaily, 16 November 2008. <www.sciencedaily.com/releases/2008/11/081113100716.htm>.
Wake Forest University Baptist Medical Center. (2008, November 16). Doctors' Questions About End-of-life Legalities May Result In Patient Pain. ScienceDaily. Retrieved July 22, 2014 from www.sciencedaily.com/releases/2008/11/081113100716.htm
Wake Forest University Baptist Medical Center. "Doctors' Questions About End-of-life Legalities May Result In Patient Pain." ScienceDaily. www.sciencedaily.com/releases/2008/11/081113100716.htm (accessed July 22, 2014).

Share This




More Health & Medicine News

Tuesday, July 22, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Gilead's $1000-a-Pill Drug Could Cure Hep C in HIV-Positive People

Gilead's $1000-a-Pill Drug Could Cure Hep C in HIV-Positive People

TheStreet (July 21, 2014) New research shows Gilead Science's drug Sovaldi helps in curing hepatitis C in those who suffer from HIV. In a medical study, the combination of Gilead's Hep C drug with anti-viral drug Ribavirin cured 76% of HIV-positive patients suffering from the most common hepatitis C strain. Hepatitis C and related complications have been a top cause of death in HIV-positive patients. Typical medication used to treat the disease, including interferon proteins, tended to react badly with HIV drugs. However, Sovaldi's %1,000-a-pill price tag could limit the number of patients able to access the treatment. TheStreet's Keris Lahiff reports from New York. Video provided by TheStreet
Powered by NewsLook.com
$23.6 Billion Awarded To Widow In Smoking Lawsuit

$23.6 Billion Awarded To Widow In Smoking Lawsuit

Newsy (July 20, 2014) Cynthia Robinson claims R.J. Reynolds Tobacco Company hid the health and addiction risks of its products, leading to the death of her husband in 1996. Video provided by Newsy
Powered by NewsLook.com
Tooth Plaque Provides Insight Into Diets Of Ancient People

Tooth Plaque Provides Insight Into Diets Of Ancient People

Newsy (July 19, 2014) Research on plaque from ancient teeth shows that our prehistoric ancestor's had a detailed understanding of plants long before developing agriculture. Video provided by Newsy
Powered by NewsLook.com
Contaminated Water Kills 3 Babies in South African Town

Contaminated Water Kills 3 Babies in South African Town

AFP (July 18, 2014) Contaminated water in South Africa's northwestern town of Bloemhof kills three babies and hospitalises over 500 people. The incident highlights growing fears over water safety in South Africa. Duration: 02:22 Video provided by AFP
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:
from the past week

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins