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July 4, 2001

Informed Consent for Public Automated External Defibrillation

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthorJody W.ZylkeMD, Contributing EditorIndividualAuthor

JAMA. 2001;286(1):47. doi:10.1001/jama.286.1.47

To the Editor: "He died a natural death when he was 90. Just keeled over," a young man once said to me, describing the death of his grandfather. When I talk with patients about end-of-life issues, I sometimes ask them what manner of death they would prefer, if they could choose. Many say that they hope for a quick death and fear a prolonged death.

It was therefore intriguing to read the article by Dr Marenco and colleagues.1 They found that automated external defibrillators (AEDs), a technology intended to avert sudden death, are rapidly infiltrating public spaces. As one who talks with people daily about choices, I like to imagine some supernatural being, perhaps a guardian angel, entering the scene as a woman who has collapsed in an airport is about to have an AED applied to her chest. The angel wants to learn the patient's preferences for end-of-life care and fortunately he can stop time briefly, thus not exposing the patient to further risks, while the angel conducts his discussion. Important topics would include the person's current state of health (other illnesses and their expected course); the likelihood that this is the only chance the patient will get to die suddenly as opposed to slowly; the diseases from which she might die the next time—those most likely, and those most unpleasant. She might, for instance, want to ponder the possibility of death from Alzheimer disease, breast or colon cancer, stroke, or amyotrophic lateral sclerosis. For the fact remains that she will eventually die of something. The angel might also feel obliged to mention the possibility that the patient will outlive some of her children or that she might spend years in a nursing home.

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