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September 20, 2000

Is It Ethical to Withdraw Low-Burden Interventions in Chronically Ill Patients?

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Executive Deputy EditorIndividualAuthor

JAMA. 2000;284(11):1380-1382. doi:10.1001/jama.284.11.1378

To the Editor: Dr Rhymes and colleagues1 agreed that removing a low-burden intervention, such as a pacemaker, from a chronically ill patient is not necessarily unethical. However, the pacemaker of the patient described, Reverend G, is an indwelling device that had arguably become a part of him. It is thereby distinguishable from extrinsic treatments like ventilatory support, hemodialysis, or artificial hydration and nutrition. Thus, acts interfering with pacemaker function would be more akin to killing than to letting die.