HSM 542 You Decide Essay


The dilemma that goes before the ethics committee is that Margie Whitson, age 95, wishes to have her pacemaker deactivated and her physician declined her request based on ethical concerns. By deactivating the pacemaker, the physician feels that patient would not survive. Mrs. Whitson’s physician, Dr. Vijay, is concerned that the deactivation of the pacemaker would be in conflict with the code of conduct and code of ethics as set forth by the American Medical Association, and his moral commitment to the welfare and livelihood of the patient.

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Therefore, the conflict arises as to whether or not the patient should have the pacemaker deactivate so that she can end her quantity of life and would this action be morally wrong?

Margie Whitson is 95 years old and is in poor health. She resides in the Golden Oaks Rehabilitation Center and is in need of constant care for daily activities. Her quality of life has diminished over the course of the last 10 years.

She suffered a hip fracture 10 years ago that physically impaired her significantly. She suffered a heart attack that nearly took her life 2 years ago, and due to good emergency care and the placement of a pacemaker she survived. Margie has lost all of her immediate family members with her son preceding her recently. She feels alone in this world, and has no immediate family members. Margie believes that her family members are in a better place now and she desires to join them at this time. Margie is a woman of great personal faith and raised her family in a religious manner. Her religion leads her to believe that there is a Heaven and that her family is waiting for her there. Margie also feels that she does not have a good quality of life due to her failing health. She is aware that the deactivation of the pacemaker may end her life. Margie has consulted with Cindy, the nursing home administrator about turning the pacemaker off. Cindy referred Margie to her cardiologist, Dr. Vijay. Dr. Vijay has never had this type of request made and feels that there is a conflict in fulfilling the request. Margie then discusses her desires to the social worker at the nursing home. The social worker recommended that she take her case to the ethics committee. The patient shows the ability to make her own treatment decisions as she has knowledge of the issues, is capable of making such decisions and there is no sign of coercion in reaching her decision. (cbhd.org, 2008). Margie shows the understanding that the deactivation of the pacemaker may end her life. She has made it known that continued treatment with the pacemaker is no longer consistent with her healthcare goals. (Pozgfar, 2012).

The ethics committee has spoken with other healthcare professionals in the community with regards to case. Several professionals feel that there is an ethical dilemma at this time to turn the pacemaker off. The professionals that feel there is a dilemma are Dr. Vijay, Cardiologist; Jane Robinson, Social Worker; and Cindy Mackin, Rehabilitation Center Administrator. The healthcare professionals on the ethics committee understand the issues presented to them and have personally communicated with the patient in regards to her wishes of the patient. Upon investigating other cases involve similar ethical dilemmas, the ethics committee has considered several cases and consultations before reaching a conclusion. (cbhd.org, 2008).

The ethics committee has evaluated this case and other cases that are similar in nature and have concluded the following: a) the patient has lost her son recently and could be experiencing depression and b) the patient has the right to ask that her device be turned off. The ethics committee views this case as a person on life support with a do not resuscitate order, which has been shown to be ethically and morally acceptable to shut off the life support. It is recommended that the following three criteria be met before consideration. 1) That the patient be advised that the deactivation of the pacemaker may not end her life immediately and that her health may deteriorate after the deactivation. She can be treated for symptoms of deterioration to alleviate any pain or suffering on an as needed basis. 2) Have a psychiatric evaluation, to determine if her wishes are due to depression that may impact her decision-making capabilities, and if so undergo treatment for a specific time as indicated by the physician. 3) If
after the above criteria is met, and the patient still desires that the pacemaker be deactivate, the ethics committee finds in favor of the patients desires and that the pacemaker be immediately deactivate with compassion. (circep.ahajournals.org, 2009), (amednews.com, 2010).

References and Citations:
“Is It Permissible to Shut Off This Pacemaker? | The Center for Bioethics & Human Dignity.” Is It Permissible to Shut Off This Pacemaker? | The Center for Bioethics & Human Dignity. N.p., 4 Mar. 2008. Web. 18 July 2013.

O’Reilly, Kevin B. “Heart Devices Can Be Turned off near End of Life.” – Amednews.com. N.p., 5 May 2019. Web. 18 July 2013.

Kay, Neal, and Gregory T. Bittner. “Should Implantable Cardioverter-defibrillators and Permanent Pacemakers in Patients with Terminal Illness Be Deactivated?” Controversies in Arrhythmia and Electrophysiiology 2 (2009): 336-39. Should Implantable Cardioverter-defibrillators and Permanent Pacemakers in Patients with Terminal Illness Be Deactivated? 2009. Web. 18 July 2013.

National Hospice & Palliative Care Organization: Position Statement on the Care of Hospice Patients with Automatic Implantable Cardioverter-defibrillators. Rep. NHPCO Board of Directors, May 2008. Web. .

Pozgfar, George. “16: Healthcare Ethics.” Legal Aspects of Health Care Administration. Sudbury: Jones & Bartlett Learning, 2012. N. pag. Print.

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