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September 20, 2000

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

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

In Reply: Drs Paola and Walker argue by analogy with the law of fixtures that a pacemaker is a biofixture, ie, that it has undergone an ontological metamorphosis and become part of Reverend G's body so that discontinuing its use is tantamount to killing him. This is a specious argument because it confuses a phenomenological transformation in Reverend G's perception with an ontological one. The pacemaker has not undergone any change in its nature and is still a mechanical device. Arguments from analogy are valid only if the similarities are necessary and inevitable and not merely accidental. Paola and Walker have not shown that the legal concept of fixtures and their concept of biofixtures are parallel in essence. Finally, their contention that Reverend G "very likely" regarded the pacemaker as part of himself is contradicted by the testimony of his valid surrogates who held that he would have wanted the pacemaker deactivated.