Ethical Considerations in Cardiac Pacemaker Therapies
Main Article Content
Abstract
Cardiac pacemaker therapies, such as implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization therapy (CRT) devices, have transformed the management of cardiac arrhythmias and heart failure, improving patient outcomes. However, these therapies raise significant ethical challenges, including conflicts of interest in device selection, dilemmas in pacing mode choices, and decisions surrounding device deactivation at end-of-life. This article focuses on the interplay between ethical principles, patient autonomy, and resource allocation in these contexts, proposing practical solutions and exploring cultural and legal perspectives. Addressing these challenges is essential to ensure patient-centered, ethically sound cardiac care.
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References
2. Hutchison K, Sparrow R. Ethics and the cardiac pacemaker: more than just end-of-life issues. Europace. 2018;20(5):739-746. doi:10.1093/europ ace/eux019. PMID: 28387818.
3. Kay GN, Pelosi F. An ethical analysis of withdrawal of therapy in patients with implantable cardiac electronic devices: application of a novel decision algorithm. Linacre Q. 2013;80(4):308-316.
4. U.S. Sunshine Act. Disclosure of financial relationships between physicians and manufacturers. 2010.
5. Finkelstein A, et al. Ethical dilemmas in cardiac device therapy. J Med Ethics. 2019;45(3): 198-203.
6. Smith SJ, et al. The impact of industry influence on medical decisions in cardiology. Circulation. 2015;131(2):101-108.
7. Heart Rhythm Society, Asia Pacific Heart Rhythm Society, Latin American Heart Rhythm Society. Guidelines for management of pacing devices in terminal illness. Heart Rhythm Society. 2023.
8. European Society of Cardiology. ESC guidelines on the management of cardiac pacing. Eur Heart J. 2021.
9. American Heart Association. Ethical considerations in deactivating cardiac devices at end-of-life. AHA Statements. 2019.
10. European Society of Cardiology. ESC guidelines on the management of cardiac pacing. Eur Heart J. 2021.
11. Netherlands Termination of Life on Request and Assisted Suicide Act. Netherlands Law. 2002.
12. Belgium Act on Euthanasia. Belgian Law. 2002.
13. Luxembourg Act of 16 March 2009 on Euthanasia and Assisted Suicide. Luxembourg Law. 2009.
14. Catholic Bioethics Center. Ethical perspectives on end-of-life care in Catholic teachings. 2017.
15. Al-Jumaily H. Islamic perspectives on deactivating cardiac devices in end-of-life care. J Islamic Bioethics. 2020;14(2):85-91.
16. UK Department of Health. Ethical framework for end-of-life care. Department of Health and Social Care. 2018.
17. European Society of Cardiology (ESC). Guidelines on cardiac pacing and deactivation. Eur Heart J. 2021.
18. American Heart Association. Ethical considerations in pacemaker deactivation. AHA J. 2019.
19. Darnell L, Harris S. The role of ethics committees in end-of-life decisions. J Palliat Care. 2022;38(4):213-220.