Should Hospice Patients be Allowed to Die in Peace when the Time Comes?
There was something I witnessed at a hospital recently that set me thinking. An elderly man with terminal cancer was battling the effects of the disease over the last days of his life. Rather than demanding more care for him though, his daughter who was attending on him, was arguing with doctor to get him to turn her father's heart defibrillator off. I went and asked the woman about the choice she was making and why. It turned out that her mother who had also died of a terminal disease, had horrible things happen because of a defibrillator. It had sent high currents into her body and whipped her vulnerable form about the bed and scared the daylights out of everyone. As much as she argued with the doctor to get him to turn it off, I saw her being given the run-around, being referred to one doctor after another to get what she needed. She would have been gladdened by news I have heard since, that hospice patients in end-of-life situations, are routinely relieved of their defibrillators in some states now. It got me thinking. What are defibrillators and why is it so important to turn them off in end-of-life situations?
A defibrillator is a vital piece of medical equipment. This small device is designed to automatically sense when the heart is begins to falter, and to send out a jolt of electrical current to give it a jumpstart. Patients get it in the form of an implant anywhere inside. A defibrillator is pretty much standard equipment for elderly patients in hospitals around the country. And more and more, they seem to threaten patients' well-being as much as they secure it. End-of-life patients needs to be allowed to die in peace. Doctors and their patients' caretakers always discuss the way to recognize when it is futile to try anymore, and to withdraw medication and artificial life-support devices. The problem is, as much as all of this makes sense, they forget to discuss the defibrillator. And when everything they do, withdrawing medication and life-support, allows a patient to gently progress towards death, the defibrillator comes up and tries to arrest it, by forcing the heart to keep beating. It is a good thing that many hospice patients get thoughtful defibrillator removal as a matter of routine. If only hospital patients could get the same.
The Heart Rhythm group, the trade group for cardiologists, is beginning public debate on the subject to get cardiologists to accept permission from their patients on how and when to withdraw defibrillator treatment. Even hospice patients cannot take the defibrillator situation for granted; only 10% of all hospices have any protocol in place on how to determine when to turn the device off. It makes no sense to place hospice patients on defibrillators at all in the first place. People go to hospices to be allowed to die in peace, not to be kept in limbo. It's just that doctors hate to talk about these things; they see themselves as lifesavers, not as people who give up.
All this does assume though, that terminal patients actually want to let go. Not infrequently, you'll see terribly ill end-of-life patients clinging to every chance they get, and insisting on sustenance by defibrillator. More than half a million patients in the country wear these implants and the number grows 10% each year. And hospices do have a policy in place; they try to deactivate it by taping a powerful magnet on the patient's chest; the magnet cuts the defibrillator out.
If a relative of yours is in the hospital or at a hospice that doesn't have a clear policy on how to treat defibrillator switch-off requests, you'll just have to try long enough. After all, it is all about lending a little bit of dignity to the dying.