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Invited Commentary
January 2014

Deathbed ShockCauses and Cures

Author Affiliations
  • 1Independent journalist
  • 2Hospice and Palliative Medicine, Stanford University School of Medicine, Palo Alto, California
JAMA Intern Med. 2014;174(1):88-89. doi:10.1001/jamainternmed.2013.11125

As he lay dying in a hospital in San Diego, a 71-year-old retired commercial fisherman was shocked 10 times by his implantable cardioverter-defibrillator (ICD), convulsing in front of his wife, 7 children, siblings, and mother. For 2 days, no medical professional intervened. The device was deactivated only at his wife’s insistence. Afterwards, she wanted to know, “Why wasn’t there a sticker on his chart? Why didn’t someone write that order?”

Life-prolonging medical innovations often create moral dilemmas that outpace effective clinical response. The pacemaker can postpone natural death even when patient and family regard death as a blessing. The ICD is primed to deliver a shock when sensing a rapid, unstable heart rhythm, and if it fires repeatedly toward the end of life, it can make a peaceful death impossible.

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