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May 11, 2011

Pacemakers and End-of-Life Decisions—Reply

JAMA. 2011;305(18):1858-1859. doi:10.1001/jama.2011.582

In Reply: Drs Lampert and Hayes draw attention to an excellent guidance document on managing cardiovascular implanted devices at the end of life and clarify that the interventional cardiologist referred to in my essay makes misstatements about pacemakers. Unfortunately, such errors are far from rare.

Lampert and Hayes state that “only about 10% of clinicians find deactivating a pacemaker at a patient's request morally objectionable,” citing an article by Mueller et al.1 A close look at this article reveals a different, more complex, and disturbing story, one that supports, rather than undermines, the notion that significant numbers of clinicians attribute a special status to pacemakers that inhibits the option of deactivation.