Ethical question

I am executor for an 89 year old female who has a 6 year old pacemaker shortly due to be replaced.

Yesterday she commented that she thought she would not have it replaced and what did I think. Of course, I told her I wasn't able to give advice on such an action but now I want to find out the ramifications of what might happen if she does refuse a replacement.
Would she just fade away or would she get horrific complications? I am sure I can guide her through this as she has a lot of commonsense. She is not a depressed person but has no family and she feels she has just had enough as she is going blind and is totally deaf.

So, members out there, please let me know what I might expect if she does take this course so that I am not 'hit up.'

With thanks for any help anyone can give me.

Sincerely,

Margaret


2 Comments

to replace or not replace?

by CathrynB - 2007-10-02 02:10:26

Hi Margt,
Wow -- this is a new one to me! I'll stay away from the emotional issues around this question, and I'm not a medically trained person, so please keep that in mind with my response too.
I certainly understand "quality of life" issues, and that's apparently what she is basing her thinking on, but I don't envy you the job of talking her through this. It's good of you to want to continue to "do the right thing".
Frankly, her cardiologist is the best person to tell you what she could expect if her pacemaker battery dies and she does not have the unit replaced. Batteries die slowly over time, and the doctor knows it's losing power if it's at that point. But the real issue is what her cardiac diagnosis is that led to her having the pacemaker and what percentage she is dependent on it. Many people on this site are 100% dependent on their PM for each heartbeat because they've had an ablation procedure done, no intrinsic heartbeat remaining and cannot generate a heartbeat without a functioning pacemaker. Others are only dependent on their PM for a small percentage of their heartbeats (2% for me) and would not die without a functioning pacemaker -- I'd just start fainting periodically. And some are 100% dependent for various reasons, but also have some remaining intrinsic heartbeat capability and would not die quickly or possibly at all without a functioning PM, but would suffer serious declines in quality of life -- activities they can do, energy, even breathing, and possibly death. So talk to her doctor for the real scoop on what to expect if she makes such a decision.
All the best as you learn and go through this process.
Take care, Cathryn

Should PM Be Replaced

by SMITTY - 2007-10-02 06:10:35

Hello Margt,

Like Cathryn, I'll not try to delve into the ethics of your situation, but I will offer a little information about what happens when a pacemaker "wears-out."

“What happens when the battery runs out?”

“Pacemaker batteries are designed to become depleted in a slow and predictable fashion. When followed over the telephone, the steady decline in energy can be followed. When the battery is low but still has significant power left, the pacemaker will still work just fine, but give indications (peculiar to each manufacturer and model) that the time for replacement is nearing. When the ERI (elective replacement interval) is reached, plans can be made for changing the battery at a date convenient for the patient and the surgeon.”

“Even beyond the ERI, pacemakers continue to pace for a long time, and do not simply stop emitting electrical energy suddenly or unexpectedly.”

Actually, unless she is PM dependant, her pacemaker may last a lot longer. In my case my PM is 7 3/4 years old and was not needed much during the first 6+ years, so they tell me the battery has an estimated remaining life of about 3 years. In view of this I would suggest that your first step would be to find out from her doctor or the people that do her checkups, what the estimated remaining life of the battery is. It could be whether she will need a PM replacement, or not, will be a moot point.

I shouldn’t, but I have to comment on something else here, although I do want to point out that I am not advocating that she take these steps. My comments are for your information only.

Assuming she will need a replacement in the near future, I don’t see any difference in her refusing a PM replacement than her refusing medication she does not want to take. Another approach is to stop having checkups on the PM then no one will know when the battery is getting weak. I know I can refuse checkups whenever I please as I have refused to have them a couple of times as they were going to interfere with my golf game. Based on what I think I know death from a PM that is no longer working as it should is not a violent death, if she got the PM because of a very slow heart rate.

I with you and the person you are caring for the very best.

Smitty

You know you're wired when...

Your pacemaker interferes with your electronic scale.

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