Name: De Guzman, Cameron Josh Section: 2BSN-A

NCM108 Case Study 4

Good Death, or Assisted Suicide?
The Case of Mr. Perry and his Pacemaker
Tarris Rosell, PhD, DMin
Mr. Perry (not his real name) was 83 years old and had several medical problems. He had spent the past several
months in and out of hospitals and rehab. Prior to that, he lived independently in a small town. Widowed many years
ago, he subsequently enjoyed the company of a lovely lady friend who lived down the street from the home. He had
five adult children and numerous grandchildren.
Life should have been relatively good for this octogenarian. But life was not good. Not anymore. “My body is all worn
out. I’m worn out. Don’t want to do this anymore, Doc. They say I can’t go home and be safe. And I’m not going to a
nursing home. No way! Just stop that little gadget that shocks me and the part that keeps my heart going. I want
them stopped. Yes, the pacemaker, too. A magnet will stop it, right? Just do it. Please.”
Tired of Fighting
Mr. Perry had a cardiac resynchronization therapy defibrillator (CRT-D) implanted a few years ago. It included an
electrical pacing component for heart rhythms, on which the patient was 100% dependent. The defibrillator had
shocked him, more than once, just before he came to the hospital E.R. with this request. That was the last straw for
Mr. Perry. No more shocks for him. No nursing home or rehab or hospitalizations or medications. And no more
mechanical pacing either. “I’m tired of fighting.”
Deactivating an internal defibrillator is one thing. The patient’s cardiologist didn’t need an ethics consultation for that
decision. “If he doesn’t want to be shocked again, that’s his decision. And if it went off again after he’d requested it
stopped, that could be a kind of torture,” she reasoned. Deactivation happened quickly after admission from the
Emergency Department. A “Do Not Attempt Resuscitation” order was placed in the chart.
But the pacemaker, also? He wanted it stopped. Ought we do so? Would that be ethically respectful of this patient’s
autonomy? Or would it be physician-technician assisted suicide? “If we stop the pacemaker, Mr. Perry, you will die
within a few minutes.” “Yes, I know. I’m tired of fighting. Please.”
Reflection questions:
1.Is it ethically right to permit the patient’s wishes to stop the pacemaker?
Yes, According to Patients' Rights under the right to appropriate medical care and humane treatment,
saying that every person has the right to health and medical corresponding to his state of health. In addition is the
Right to Self-Determination, wherein the patient has the right to avail himself/herself of any recommended diagnostic
and treatment procedures. As has already been stated, patients have the right to discontinue medical procedures
and in this context, pacemakers are no different from other surgical treatments such as dialysis, chemotherapy, or
ventilation. Yet pacemaker deactivation may appear different from the practitioners involved, more like aggressive
euthanasia than the removal of life-sustaining action.

The following personal principles are important for the solution to the problem: responsibility, knowledge, dedication,
integrity, expertise, fairness, leadership, preparation, professionalism, respect, confidence, and wisdom. Patients
have the right to withdraw medication, and pacemakers should not make a huge legal distinction with their
deactivation. However, doctors can be hesitant to deactivate a patient pacemaker for a number of reasons. In any
event, it is essential to understand and discuss these reasons in order to advocate for patients and to negotiate an
appropriate care plan. If the pacemaker is to be deactivated, the patient should be made aware of the related
complications, advantages and options, including the possibility of experiencing additional cardiac problems, and the
electrophysiologist should be included in the decision.
2. Is informed consent still necessary in end life decision of Mr. Perry?
Yes, with respect to Mr. Perry’s wishes it is necessary that he is informed in ending his life, accompanied by
his love ones it is time to say his last wishes and farewells. It is also stated in Patient’s Rights under Right to informed
consent and in right to information, where in it is said that the patient has a right to a clear, truthful and substantial
explanation in a manner and language understandable to the patient and alongside of the course of his treatment
and hospital care.
3. What is the nurse’s responsibility and course of actions on this situation?
The nurse shall be responsible to the patient, the families, and the staff responsible for the treatment
rendered. Having knowledge of pacemaker deactivation rules and procedures is essential. As a specialist, the nurse
has the skills and experience required to handle the patient. Preparedness is important to address family questions
or complaints in a frank and friendly way. The nurse must have an understanding of this issue, both the advantages
and disadvantages of the action, in order to appreciate the legal issues inherent in meeting the desires of the family.
It is important that nurses address treatment plans and informed consent with patients prior to the period when those
questions cannot be answered. Patients and family members need to learn about and express their wishes for end-
of-life treatments before such actions need to be taken. We are faced with multiple challenges as nurses. When time
is scarce, decisions must be reached in a rush. Any decision is taken in an ethical problem similar to that outlined
here, decision-making and the method of decision-making will lead to significant psychological and moral distress.