Recommended Citation
Grannan H, Battle-Miller K, Sharma K. A heart-breaking decision: An Ethical Dilemma Involving Pacemaker Deactivation at End of Life. Poster presentation at: International Conference on Medical Ethics Cases; September 24, 2025; Toronto, Canada.
Presentation Notes
Poster presentation at: International Conference on Medical Ethics Cases; September 24, 2025; Toronto, Canada.
Abstract
Background Requests for pacemaker deactivation at end of life raise unique ethical challenges. Physicians often experience moral distress when patient autonomy conflicts with perceived duties of beneficence and non-maleficence. Case A 74-year-old man with metastatic renal cell carcinoma receiving checkpoint inhibitor therapy presented with third-degree heart block. He underwent extensive evaluations, including cardiac catheterization, transvenous pacing, and steroids. After two cardiac arrests, a permanent pacemaker was implanted. Despite treatment for several weeks, he experienced progressive functional and nutritional decline. He requested pacemaker deactivation with goal of comfort focused care. The hospital ethics committee affirmed his decisional capacity and noted that pacemaker deactivation is ethically equivalent to withdrawal of other life-sustaining interventions. The treating cardiologists declined deactivation, citing ethical concerns. The patient was transferred to inpatient hospice, where prior deactivations had occurred, but the device manufacturer refused to assist due to liability policy changes. He died eight hours after admission, with the pacemaker still functioning. The family expressed significant emotional distress that his wishes were not honored. Conclusion This case illustrates the ethical and logistical barriers to pacemaker deactivation in terminal illness. Unlike defibrillators, pacemakers are often perceived as continuously life-sustaining, amplifying reluctance among physicians and industry partners. Institutional policies, proactive advance care planning, and interdisciplinary ethics support are essential to reduce clinician distress and ensure patient-centered care.
Type
Poster