When Your Pacemaker Outlives You. Add to Your Utah Advance Healthcare Directive

Nobody really knows exactly how many Americans are walking around with pacemakers and defibrillators. But with surgeons implanting at least 225,000 pacemakers and 133,000 defibrillators each year, “there probably are a couple of million” out there now, said Dr. Paul S. Mueller, a Mayo Clinic general internist and bioethicist.

The devices prolong lives, but “all those people will face decisions down the road,” Dr. Mueller said. “’Do I keep it going? Do I turn it off?’” Physicians have similar questions, including what kinds of patients confront these choices and who usually winds up making these decisions.

Do you or a loved one live with a pacemaker or implanted defibrillator? How do you plan for end-of-life matters when one of these miraculous medical devices can keep you going and going and going long after your other essential bodily functions are otherwise shutting down? This scenario is all too common and is presenting challenges in geriatric medicine and palliative care.

Recently, The New Old Age Blog took a look at this perplexing issue in an article titled “A Decision Deferred: Turning Off the Pacemaker.”

Compounding the problem is the fact that standard medical directives are designed with feeding tubes and breathing support in mind. Rarely do such legal instruments address the question of a pacemaker, implanted defibrillator or other surgically implanted electronic heart monitor. Part I Section (F) of the Utah Advance Healthcare Directive does allow you to specify additional instructions to your agent about your end of life options.  If you have one of these devices please consider providing instructions to your agent in this section.  These devices may extend life, and maybe not for the better, but without the directive who is empowered to direct when or even whether they should be turned off?

Simply put: no one.

So how many patients with these devices have built their wishes (whether on or off) into their plans and medical directives? In one survey of 150 elderly and dying Mayo clinic patients, more than half had a medical directive (and only that — a bad statistic in itself). However, only one medical directive addressed the issue of the patient’s defibrillator. Please discuss this in Part I Section F of your Utah Advance Healthcare Directive.

Reference: The New York Times – The New Old Age Blog (January 29, 2014) “A Decision Deferred: Turning Off the Pacemaker”