to the editor: I read the Curbside Consultation, “Ethical Considerations of Patients with Pacemakers,” with amusement and consternation. The authors of the commentary section highlight the dilemma associated with technology intended to extend a person's life and enhance the quality of their life. They present a case of a terminally ill patient who had clearly conveyed his wishes that any therapy prolonging the dying process be withdrawn. In this scenario, the ethical dilemma, though not immediately answerable, is at least discernible given one's religious and philosophical perspectives. What concerns me about the article is the authors' recommendation about how to determine if a pacemaker is life prolonging. They state, “In [this] case, the pacemaker was placed for complete heart block and was prolonging the dying process.” The authors suggest that the easiest way to determine if a pacemaker is prolonging the dying process is to interrogate the device. If the rhythm is completely dependent on the pacemaker, it is considered to be life prolonging, and, thus, turning it off is justifiable.
This assertion made me chuckle and cringe. Being the recipient of a pacemaker two years ago, I am completely dependent on the device. During a recent routine pacemaker interrogation, a young technician turned the pacemaker off to determine my underlying rhythm. There was none. I am glad that he had the good sense to turn it back on rather than to assume that it was prolonging my dying process. We are all in the process of dying. Knowing how and when we are going to die is a more complicated question than a pacemaker can answer.