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Medical Reasearch

In: Social Issues

Submitted By catrippe79
Words 5146
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Case 1: Is It Permissible to Shut Off this Pacemaker?

The following case is based on a real clinical dilemma that led to a request for an ethics consultation. Some details have been changed to preserve patient privacy. The goal of this column is to address ethical dilemmas faced by patients, families and healthcare professionals, offering careful analysis and recommendations that are consistent with biblical standards. The format and length are intended to simulate an actual consultation report that might appear in a clinical record and are not intended to be an exhaustive discussion of the issues raised.


Dorthea is a 69-year-old woman who was well and active until about five years ago when she developed diabetes. She was admitted to the hospital 18 months ago with recurrent fainting and was found to have an intermittent transient heart block1. She reluctantly consented to insertion of a permanent pacemaker.

Three months ago her kidney function was found to be diminished to about 10% of normal, probably caused by her diabetes. It was expected that she would soon require dialysis. However, her kidney function has since improved so that dialysis will not likely be needed for some time. She has since said she would refuse dialysis even if it were needed, and she has refused treatment of her profound anemia. She did consent to a colonoscopy last month to see if she had cancer (malignant change was found in one small area, presumably cured). She is now asking that her pacemaker be turned off so that she can die.

The ethics consultant met with the patient and two of her daughters. Dorthea says she wants to die now because (a) she misses her husband who died three years ago after 45 years of marriage; they were very close, did everything together, and she says she can’t live without him; (b) she can’t stand to live in their...

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