Ethical Question About Pacemaker - page 3

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

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    As a new nurse, I know it will be hard for me to face situation similar to this in the future! I find this thread very helpful as I already have the idea how to deal with it if my time comes!

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    Just a little disclaimer, a person can still die while a pacemaker is active. I have looked up many a time and seen only pacer spikes only to be coding seconds later. Just for those who may not know.

    I believe you did right as well. To me, it's about the patient. If he expressed his readiness to go and was in his right mind, let him go. Bravo to you! I know that had to be hard.
    Last edit by qdiva411 on Feb 4, '13
    umcRN, somenurse, and fromtheseaRN like this.
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    Allowing someone to die is part of nursing (palliative care when ordered).

    Making someone die is murder.

    Sounds like the ethics committee needs to be involved
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    OP: You keep referring to the patient as "them". Is this a subconscious referral to the entire family and their wishes?
    KelRN215 likes this.
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    There are a lot of things we do to/for dying patients that are difficult for new nurses and the outside world to grasp. It can feel like you're doing more than just allowing a terminally ill person to die. Personally, I agree with turning off the pacemaker and view it as similar to turning off a vent. When I worked in the hospital, I worked in neurosurgery and recall a handful of times where we had patients who were dying but had EVDs in place. The EVD was draining their excess CSF and therefore keeping their ICP from rising to dangerous levels. There were a few times when the decision was made to pull the EVD and allow the patient to herniate resulting in immediate death. I recall two cases where the patient was vented in the ICU with EVDs and countless other lines in place... the parents chose to end treatment and bring their children home. In both cases, Palliative Care and ICU MDs as well as nurses accompanied the patient home, the lines/tubes were all dc'd and the patient passed in his/her own bed within a matter of minutes.
    Sugarcoma and Altra like this.
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    Quote from classicdame
    OP: You keep referring to the patient as "them". Is this a subconscious referral to the entire family and their wishes?

    No, this common verbal/written quirk is because many people think "they/them/their" are more all-inclusive words than they are.

    For example: "I gave my patient a bath and they told me it was the best bed bath they'd ever had. I thanked them." My internal response is always, "They who? And what are they all doing in that poor man's bed?"

    The correct pronouns to use about a single individual are "he" or "she," and "him" or "her." The adjectives are "his" and "hers."

    "Them," "they," and "theirs" are for the plural-- people.

    If you don't want to indicate gender here, say, "the patient," use a neologism like "s/he," or recast your sentence so it's all plurals. "My patients always tell me how much they love their bed baths. I thank them."

    Thus endeth today's lesson. We return to your regularly scheduled thread.
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    We rarely have to DC pacers in hospice...defibrillators are quite a different matter as has been addressed in earlier comments.

    Most of the time, our patients will die regardless of pacing and it is typically not necessary to DC the device.

    Some hospices consider discontinuation of a pacemaker as an action intended to shorten the lifespan and refuse to participate...
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    Who gives a rat's behind about what the hospice wants.

    It's never about the hospice, or the nurse. It's always exactly what the patient wants.
    Sugarcoma, Susie2310, KelRN215, and 3 others like this.
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    I dealt with the same issue on a personal level. My grandmother had an AICD, and when we put her on hospice, the MD ordered the pacemaker rep out to "d/c" it. But he didn't write whether to d/c the pacer, the defibrilator, or both. The pacemaker rep disabled the defib but refused to stop the pacer itself, citing that a pacer will not keep a dying heart from dying. I argued that there was no need to have the pacer in a woman who was in MODS and expected to pass at any given moment, completely unresponsive (for days), DNR in place, literally with her family surrounding her, ready to go.

    I should back up a bit and say that the pacemaker rep took forever to get there to turn the AICD off--12 hours in a patient who wasn't expected to even live another 12 hours. I had already had my brother go to the local Tractor Supply and buy me a big magnet. (I found it odd that the hospice nurse didn't have one? Is this not something they deal with on a fairly regular basis? Maybe not.) I refused to let my mom and her siblings see their mother being shocked just because the pacemaker chick couldn't find it in her busy schedule to get there and turn it off.

    Anyway, to the OP, I think it was a huge oversight that the MD didn't write to have the pacer d/c'd in the patient. It was cruel and awful that the patient suffered and wasn't allowed to die as a result of this MD's negligence. You did the right thing. In my experience with dying patients, sometimes it takes a bit to begin to feel like you did the right thing.

    And, yes, 20 mg of Morphine, not 4 mg. Everytime.
    Sugarcoma likes this.
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    Quote from classicdame
    Allowing someone to die is part of nursing (palliative care when ordered).

    Making someone die is murder.

    Sounds like the ethics committee needs to be involved
    The ethics committee does not need to be involved. The OP did not kill a pt they removed/ stopped a medical device which was keeping the pt alive. They followed the pts wishes and did the right thing.
    Sugarcoma, Altra, KelRN215, and 2 others like this.

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