Pacemaker- A BOON TURNING INTO CURSE ?

I am a prospective candidate for Pacemaker as per my cardiologist, though I do not have any symptoms and leading peaceful retired life at 74 age.  Looking at a few posts, the following doubts cropped up. 

Q1:- Are there any cases where PM might cause hindrance to a peaceful death process for the patient on the deathbed?

Q2:- If it turns out to be an obstacle to a natural death for the patient, does USA law allows the deactivation of the device?  

Thanks

Jay


5 Comments

Pacemaker interferes with DNR?

by AgentX86 - 2018-09-26 08:31:44

It depends on your definitions. A pacemaker will do what it's intended to do. It will keep your heart beating if the natural pacemaker (SI node) stops working, for example. In that sense it will keep you from dying. It's not going to magically keep you alive if you have a massive stroke, for instance. It may keep pacing but your heart will stop and you will be dead.

Pacemakers are more about quality of life than extending life, though under very specific circumstances they do that too.

Yes, you can have a your pacemaker, or that of someone who has entrusted you with a power of attorney, to have a PM turned off. I don't know what the process is in a hospital but there will be a protocol, just as if it were a ventilator.

depends...

by ROBO Pop - 2018-09-26 18:55:56

and I don't mean the adult diapers.

When doing my DNR and final planning I discussed these topics with my Cardiologist at length. Here's what he said, and I expect he knows of which he speaks...

Q1 - Depends on what causes death. There's a saying, well My Cardiologist told me it, You can't beat dead meat. Yeah your pacemaker may keep you alive but if your heart is gone, it won't help. The scenario you mentioned is right. and lets bear in mind the definition of death is actually cessation of brain function in most places, so your heart can stop but you may not be dead. By the same token there are lots of people who have no brain function but are considered alive. 

Q2 - Depends on where you live. For example, in Arizona it is illegal for a doctor to shut off the pacemaker function if you are pacemaker dependent. Now bear in mind you can be paced 100% and not be pacemaker dependent. Pacemaker dependent means if they shut off your pacer your heart won't beat, even slowly. It's considered euthanasia. That does not apply to shutting off a defibrillator function (Jesus Jolts), nor a pacemaker for someone who is not dependent.

Also make sure you know and understand the laws where you expect to die regarding final wishes and authority over it. Again the law does not always recognize Power of Attorney. We had Power of Attorney over my wife's aunt, which was drawn up by an attorney, the aunt signed, and it was filed with the courts and yet the state would not recognize it for many purposes and required additional stuff. What a pain in the derriere.

So you have conflicting information, may I suggest you not believe strangers and do your own homework on these topics. 

Politicians can make dying and ugly process

 

premature

by dwelch - 2018-09-28 01:17:20

On the other side of this the pacer may extend this peaceful retirement.  Your retirement may be cut short without it.  I am fairly certain I would have only lived about half as long as I have without this thing, got to live to raise a child thanks to it...

it is a good set of questions, I dont know if I have seen these questions here before.  I wouldnt trust paperwork how may times have we heard stories of patients with a DNR that the folks in the ER or wherever didnt know existed or didnt have time to look.  Same here are they going to bother to look for some paper work or just going to treat you like anyone else in a certain condition.  And they have to get the right doc/tech/and hardware to even talk to the device in any way, nurses making phone calls, pagers going off, eventually hours later the on call cardiologist shows up, has to go find the box, etc, etc... and then as posted above the laws may prevent it anyway if and when they get you connected with the right person and hardware.

on the first question, pumping blood isnt the only thing keeping us alive, its just one part of it, without the minimum set of parts, we are not alive.  Otherwise CPR would work every time and it doesnt...My understanding is it rarely works, but I have not seen statistics...The pacer is going to keep pacing because you are below your lower limit, but that wont keep you alive all by itself.  and a minimum pace shouldnt cause any additional pain nor prolong any.  If it was your natural pacemaker being the one thing in the minimal set of things that keep you alive, then the pacer is doing its job, the reason why so many of us in this forum are still here, becasue it is doing its job.  but of brain function goes away and you stop breathing, thinking or otherwise and they dont ADD any more machines/devices then the pacer wont make a difference any more than your natural pacer would have or CPR (properly done CPR DOES hurt, it can break bones, rather have a pacemaker)

it would be nice to have a FAQ or paper or otherwise that shows for the USA, UK, India, and the many many other countries (even though they may not be english speaking and may not be bothering with this site) what the general rules are for turning off the device.  Be they country or state by state.  Are there places where when say a breathing machine is turned off the pacer can be turned off too or is it another level beyond that before it can be turned off?

second comment

by dwelch - 2018-09-28 01:19:45

Q2:- If it turns out to be an obstacle to a natural death for the patient, does USA law allows the deactivation of the device?

My pacemaker IS very much an obstacle for natural death, by design.  Wouldnt be here otherwise would have likely died naturally a long time ago.  Why bother to put it in in the first place to then just turn it off and let me suffer then die.

Peaceful Pacing or Not

by GoGranny - 2018-10-01 18:10:31

My daughter and I have learned alot from your forum. Thank you.

In regards to the Natural Passing comments I have a true scenario. 

My neighbor was homebound and kept falling on a daily basis. After several falls in one week and while bandaging and helping him up my daughter noticed he had a pacemaker and insisted he go to the hospital. She was livid when she learned that out of all the "routine" housecalls from his "medical team" not once did they send a PM tech nor did they transport him to a heart doctor for PM testing. They only checked and nursed his wounds along with BP, and pill checks.

It was in the ER that my daughter was informed that his battery/pacer had stopped working not months but years prior. My daughter and I, not educated in the area of pacers, thought that when a pacer stops, the hearts stops and you pass on; seems natural enough. This is not always the case as each person/model may be different. Being more educated now I believe it depends on your health and percentage of pacing your heart is using. (?)

My neigbor's choice was to elect for another PM surgery or live it out with the possibility of exhaustion and falls. He opted for another pacer surgery and went on to make many more happy memories. Had he not opted for the PM surgery no one knows how much longer he would have lived but we do know that his days would have been faced with challenges of extreme exhaustion, disorientation and falls, just as he was when it stopped working. Falling is not the quality of life I want after my pacer stops.

In answering dwelch's question. My daughter says that he had the choice to put in a new PM or not put one in while in ER. Had he been unconcious his next of kin would have made that decision.  Apparently there is only the choice of changing the battery/PM or living without it but deactivation to speed up a peaceful passing doesn't seem to be a choice since how much time one may live without a PM is not known. To deactivate it may be against a doctor's code of ethics. You are right, why have one to later take it out and suffer?

My daughter will tell you she is glad I have one as I flat lined before the surgery. I also would not be here today. She stays on top of my health and makes sure that I have regular check ups and that results are confirmed and printed for me so they are on hand for any emergency.

 

 

 

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