New guidelines released for hospice patients with defibrillators

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New guidelines covering implanted defibrillators in terminal patients should help patients, doctors and hospice caregivers decide how to proceed with end-of-life treatments, experts say.

Up to this point, there were no official guidelines concerning defibrillators and end-of-life care. Doctors at Yale University School of Medicine and the Mayo Clinic assembled a committee of healthcare experts, including a nurse, psychiatrist and ethicist. At a meeting of the Heart Rhythm Society in Denver on Friday, they unveiled the guidelines, which reflect a consensus view from the committee.

The guidelines recommend that all patients with implanted electronic devices be encouraged to make advance directives, and to decide on their own whether or not to remove the device. The committee says that adult patients should be assumed to be competent, but if they are incapacitated, a healthcare proxy should make a decision. Physicians and caregivers should not be compelled to perform tasks that conflict with their ethical values, the group also recommends.

A recent study found that of 400 hospice care providers only 20% made inquiries into implanted defibrillators, and only 10% discussed turning off the devices with the patient. (McKnight's, 3/8/10) The new guidelines will provide caregivers with a frame of reference based on a number of different perspectives when making end-of-life care decisions, the expert presenters said. A statement expressing the consensus view of the committee will be published in the July issue of HeartRhythm.