When Your Pacemaker Outlives You in Virginia

PacemakersNobody really knows exactly how many Americans are walking around with pacemakers and defibrillators. But with surgeons implanting at least 225,000 pacemakers and 133,000 defibrillators each year, “there probably are a couple of million” out there now, said Dr. Paul S. Mueller, a Mayo Clinic general internist and bioethicist.

The devices prolong lives, but “all those people will face decisions down the road,” Dr. Mueller said. “’Do I keep it going? Do I turn it off?’” Physicians have similar questions, including when does their patient need to confront this difficult question and who usually winds up making this decision.

Do you or a loved one live with a pacemaker or implanted defibrillator? How do you plan for end-of-life matters when one of these miraculous medical devices can keep you going and going and going long after your other essential bodily functions are otherwise shutting down? This scenario is all too common and is presenting challenges in geriatric medicine and palliative care.   Recently, The New Old Age Blog took a look at this perplexing issue in an article titled “A Decision Deferred: Turning Off the Pacemaker.”

Compounding the problem is the fact that standard medical directives are designed with feeding tubes and breathing support in mind. Rarely do such legal instruments address the question of a pacemaker, implanted defibrillator or other surgically implanted electronic heart monitor. These devices may extend life, and maybe not for the better, but without the directive who is empowered to direct when or even whether they should be turned off?  Simply put: no one.

So how many patients with these devices have built their wishes (whether on or off) into their plans and medical directives? In one survey of 150 elderly and dying Mayo clinic patients, more than half had a medical directive (and only that — a bad statistic in itself). However, only one medical directive addressed the issue of the patient’s defibrillator.

You can learn more about this topic as well as other strategies on our website under the tab entitled: elder law planning in Virginia. Be sure you also sign up for our complimentary e-newsletter so that you may be informed of all the latest issues that could affect you, your loved ones and your estate planning.

Reference: The New York Times – The New Old Age Blog (January 29, 2014) “A Decision Deferred: Turning Off the Pacemaker”



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