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- W2012903600 abstract "A n informed patient’s right to discontinue life-sustaining treatment is widely accepted both ethically and legally,1-3 yet physician practice patterns appear to have lagged behind.4 We believe that such reluctance occurs in part because many physicians do not have a coherent way of approaching these situations. We begin by presenting a complex patient who requested that his implantable cardioverter defibrillator (ICD) be discontinued to illustrate the process and its potential pitfalls. We will then explore the ethical principles that guide such requests for patients with a capacity to make decisions, and propose practical guidelines for discontinuing life-sustaining interventions such as ICDs. Mr. W. was a 67-year-old man with coronary artery disease, degenerative joint disease, osteoporosis, and emphysema who had been asking to have his ICD turned off for over 1 year. He sustained his first myocardial infarction in 197.5, and underwent coronary bypass surgery in 1976. An ICD was implanted in 1990 after multiple cardiac arrests from his severe ischemic cardiomyopathy. His ICD fired every 4 to 6 weeks, often preceded by a brief presyncopal episode. Although he feared the associated electric discharge, he knew that each shock probably prolonged his life. As the burdens of his multiple diseases increased, Mr. W.‘s activities became increasingly restricted. For the last 2 years of his life, he felt his condition to be unbearable. Although he had a devoted wife and attentive physicians, he could see no hope of improvement, and no escape from his steady decline. He had accepted his" @default.
- W2012903600 created "2016-06-24" @default.
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- W2012903600 date "1994-07-01" @default.
- W2012903600 modified "2023-09-24" @default.
- W2012903600 title "Discontinuing an implantable cardioverter defibrillator as a life-sustaining treatment" @default.
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- W2012903600 doi "https://doi.org/10.1016/0002-9149(94)90107-4" @default.
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