Ethical Question About Pacemaker - page 2

by Nursingbride12

14,396 Views | 55 Comments

Hi all! I have an ethical/end of life question for you. I had a patient who had a pacemaker placed in the 90s as well as an AVR a couple years previous to this visit. The patient was a young patient in the 50's and just had a... Read More


  1. 1
    Yes exactly, I view vents/pacers etc. as only serving to make the patient a lab rat when wishes to just be done with it all have been expressed. To me it's gross to keep tweaking the body into doing tricks when the person living in that body wants off that ride.
    somenurse likes this.
  2. 1
    Thanks for all the replies I'm glad did the right thing but for me this feels like the hardest part of our job.
    I did give them 4mg of morphine before the tech got there so I'm confident they slipped away in peace.
    somenurse likes this.
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    Again, you did a great job of advocating for your patient's wishes and helped him die with comfort, dignity, and respect.

    I did a palliative fellowship and I was oft stuck by how emotional terminal care could make me, even when I knew I was doing the right thing. We had weekly meetings as a team to discuss our feelings, and it was a big help to me.

    You absolutely did the right thing for this patient, but that doesn't mean it won't sadden you or make you reassess you actions, but it was the right thing.
    tewdles, merlee, and somenurse like this.
  4. 5
    In time allowing for a peaceful, comfortable death will become one the best parts of your job. You will be sad a life is lost but the peace that comes over the pt because they are no longer suffering will be victorious. We can't save them all, the body can only take so much. Once they are terminal, letting go is the best. You will see many pts suffer as families try to keep them here when the body is done.. This gentlemen,you and his family, while hard did the best thing.
    Sugarcoma, merlee, KelRN215, and 2 others like this.
  5. 3
    You saw something the rest of the team had overlooked, and you were not afraid to advocate for your patient. You sound like a great nurse, and if I would want you taking care of me.
    merlee, FecesOccurs, and somenurse like this.
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    They? There were more than one of these patients in your care? Please use singulars for one person; I thought "they" referred to his family or his caregivers and had to read this about three times to get it straight. Sorry to be so dense.

    I did find this a little confusing to read, but once I figured it out, I was so glad that the patient was able to express his wishes and say he was ready to die. A pacemaker isn't any more magical than any other piece of medical equipment, as others have so ably described above. Anyone can refuse care of any kind at any time. It that patient had been me or a loved one, I'd have said, "20mg of MS push(4mg is almost homeopathic), count to ten, and turn it off."
    Sugarcoma, Altra, tewdles, and 4 others like this.
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    Agree with what the other posters have stated. It is very similar to extubating or withdrawing other kids of external support. A place I worked at a few years ago had a patient who was the very first one to have their LVAD turned off. In time pt had become no longer a transplant candidate and the LVAD was the only thing keeping her in a very painful life, she also had an ICD which gave frequent shocks through the day. She was in daily misery and with the LVAD and ICD off, was finally able to go in peace.
    somenurse and
  8. 1
    Sorry for the confusion! I just had 1 patient in this particular situation. It was my first case where I was the primary RN so I was trying to sort it all out mysel.
    somenurse likes this.
  9. 0
    I don't see this as any different from removing a vent; the circumstances are a bit more unusual, but the bottom line remains the same. Turning it off honored the patient's wishes.
  10. 2
    Quote from Nursingbride12
    Hi all! I have an ethical/end of life question for you. I had a patient who had a pacemaker placed in the 90s as well as an AVR a couple years previous to this visit. The patient was a young patient in the 50's and just had a "bad" heart. Trouble with arrhythmias and all other sorts or problems. Well a couple of years ago they found out their new valve was dehissing. They needed surgery to replace it but he had already gone into kidney failure and bad heart failure and was refusing surgery due to unwanted more stress on their already fragile body not to mention family. So this visit they came in with shortness of breath and a DNR. Specifically no shock and no intubation. They were put on BiPAP, Levophed, epinephrine, dopamine, and Milrinone. About the third day of inpatient with the pt no longer responding to stimuli and having to keep titrating drips up and up the family decided enough was enough and that's not what the pt would want. So they decided to completely withdraw care. The pt was taken off BiPAP and was weaned down on all of the drips. I come in the next morning and come to learn that the pt is still alive. I get report from a newer nurse and something stands out to me. She is telling me the pt woke up and tearfully told their family member they was ready to go and wanted to go to heaven. The nurse said she had been pushing morphine to keep the pt comfortable etc. but then the nurse told me that his HR was PACED at 70. Well, he had an internal pacemaker/defib. My charge asked if it had been talked about if they had discussed turning off the pacemaker... Considering that was the only thing keeping them alive. When I discussed with the family, no one had brought it up before, and within 2 hours we had a dr order, the electronic company who had placed device up there, IOPO called, and the device off. The pt had no underlying rhythm and respiration a ceased immediately.

    My question is, I felt incredibly uncomfortable that turning off the pacemaker was an option. I felt that considering it was a device keeping them alive, that turning it off would force them to go instead of weaning down a drip or w/e. Older nurses have compared it to pulling the patient off a ventilator... its a machine coming off when the body is no longer working.
    Am I being too emotional?
    I work in the ER of a VA hospital, had a patient come in from the hospital's nursing home, they called ahead of time saying they just wanted an EKG to make sure the pacer/defib was off. He had been trying to pass on for weeks, but this past day he was continusly being shocked by the interna defib. They only had to pass a magnet over him, did an ekg, no paced rhythm, and they were back on their way and he was much more comfortable. That has to be uncomfortable to be shocked like that.
    GrnTea and merlee like this.


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