Pacemakers & Sustained Life During Hospice

Maybe you recall, I was accused of needlessly prolonging my Auntie’s life almost two years ago, when I made a decision, to the consternation of the Sister to the South (My Auntie’s sis), to have the doc’s insert a pacemaker into my Aunt’s chest. This made all the difference. 

Now the Southern Sister is yet again raising this issue as to why my Auntie is in this prolonged departure….it is my fault and that ever-ready bunny pacemaker too.

I sit and listen to her churning out 30+ rapid breaths a minute, minute after minute through the night…you do take a moment to consider this seemingly too efficient clinging to life….’is this normal or is that damn pacemaker somehow contributing to this extended life plan?’ Well, rest assured….as grotesque as it seems…that pacemaker will be clicking on for quite a few years, long after Auntie has joined her loved ones in heaven.

Pacemaker Function at Time of Death

Patients and their families often make assumptions that pacemakers prolong the dying process and thus prolong suffering. However, a pacemaker is not a resuscitative device. In general, pacemakers do not keep dying patients alive, as terminal events are often due to sepsis, hemorrhage, pulmonary emboli, or arrhythmias from metabolic abnormalities associated with end-stage cancer, liver, or renal failure. At the time of death, the myocardium is usually too sick to respond to the pacemaker generated signals.

When is Pacemaker Deactivation indicated?
In contrast to popular belief, it is rare that disabling the pacemaker will result in a swift and painless death as few patients are 100% pacemaker dependant, particularly during the period of imminent death…..”

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‘That Damn Pacemaker is Keeping Her Alive!’

“Now let’s talk about what happens to the heart at the moment of imminent demise.  One thing that a healthy body does really well is eliminate waste products (and, no, I am not complimenting you on your talents in the bathroom): the lungs eliminate carbon dioxide and the kidneys and liver break down and eliminate unwanted metabolic byproducts.  As these important organs deteriorate your blood becomes saturated with metabolic detritus and becomes an inhospitable milieu for normal cellular function.  Most notably, the pH of the blood drops and the normally neutral serum slowly turns into a weak acid.  Once the pH falls more than a fraction of a point the heart muscle becomes incapable of propagating an electrical stimulus or mounting an effective ventricular contraction.

In other words, no amount of external electricity will trigger a contraction once the heart muscle becomes electrically inert and mechanically dormant.  Step 1 (in the cascade described above) doesn’t matter once steps 2 and 3 fail.  It’s for this reason that we don’t turn off pacemakers in dying patients—it just doesn’t make any difference.”

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2 thoughts on “Pacemakers & Sustained Life During Hospice

  1. Beth

    How quickly will death occur when a person is 100 percent on a pacemaker & the device is deactivated? If the person has almost no quality of life (bed ridden 8 years) and now on hospice is it ethical for a doctor to put in a new battery when the patient is 100 percent dependent on a pacemaker?

    1. Well you raise those very difficult questions. In the end death won out over my Auntie’s battery. Whether it continues to tick away I am not sure. I asked at the mortuary and I seriously cannot remember what they said re the prep etc.

      I cannot answer the questions. I wish you and your family member the very best in the journey ahead.

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