Is Deactivating Defibrillators Assisted Suicide?

Amid the ongoing debate about whether patients are getting the best end-of-life care, a University of Pennsylvania team at AHA 2014 presented results from a survey on a potentially serious ethics question. James Kirkpatrick, MD, of the University of Pennsylvania in Philadelphia, PA, said he and colleagues wondered how terminally ill patients would feel if doctors turned off their implanted defibrillators—against the wishes of patients or family.

“It’s never happened to me and I would never do that against a patient’s wishes,” Kirkpatrick said in an interview at a poster session at the American Heart Association Scientific Sessions in Chicago, IL. But the answers patients gave surprised him.

“One said he thought that would be homicide,” Kirkpatrick said.

The basic question was whether deactivating such a device in cases where further care was likely to be futile, and patients had do-not-resuscitate orders in place would be considered physician-assisted suicide.

The respondents were a group of 60 patients who had the devices. The legal concern, Kirkpatrick said, is that since the physician must touch the patient to deactivate the device, the action could arguably meet the definition of battery (as in assault and battery).

“You could see a scenario where the patient’s family did not want the device deactivated and they might be throwing themselves between the doctor and the patient,” he said, which would be awful.

Most patients in the survey said they had not given any thought to whether they would want their device turned off if they developed a serious illness from which they were not likely to recover, he said. Patients who were single were more likely to have thought about it, and though 53% of respondents had advance directives, only one patient’s directives included device deactivation.

A majority, 77% did not consider deactivating the device physician-assisted suicide. But they clearly wanted to be in on the decision, with 78% responding that it would be unethical for a doctor to turn off the device against the patient’s wishes. The patients surveyed had been living with their devices for an average of 6.74 years were mostly Caucasian (82%) with 15% African American and 3% Hispanic. They were surveyed at quaternary medical center outpatient electrophysiology practice.

Kirkpatrick said the legal questions need to be answered. “You hate to see people staying in the ICU getting shocked and [revived] but not getting better and running up costs and bills,” he said, when patients just wanted to end their lives with some dignity.