End-of-life and other ethical issues related to pacemaker and defibrillator use in the elderly.

In the past decade, the rate of implantation of pacemakers and cardioverter-defibrillators in the elderly with cardiac impairment has soared. As patients near the end of life, interventions become more complicated and expensive, and less effective. In this context, "informed consent" requires consideration of issues different from those faced in more routine settings.

Ethical issues in the management of geriatric cardiac patients.

The cardiologist acted in good faith, which resulted in losing the legal battle, the support of the hospital administration, and the friendship of the pulmonologist.

Ethical issues in the management of geriatric cardiac patients.

Ethical Issue: A hospital's Ethics Committee decides to not give analgesics to a terminally ill patient to relieve her pain.

Ethical issues in the management of geriatric cardiac patients.

Ethical Issue: When referred to hospice care the treating cardiologist believed that his patient would die in a few days. Instead, the patient lived over 18 months.

End-of-life medical treatment of older cardiac patients.

The last decade saw breathtaking advances in the science and technology of heart disease. Fewer patients die from an acute myocardial infarction or acute stroke, or have a sudden death. Thanks to modern technology, people live much longer, but more than half still die of heart disease, mostly chronic.

Routine implantation of cardioverter/defibrillator devices in patients aged 75 years and older with prior myocardial infarction and left ventricular ejection fraction < 30: antagonist viewpoint.

The Multicenter Automatic Defibrillator Implantation Trial (MADIT II) investigators assert that their results justify the placement of artificial implantable defibrillator cardioverter devices in patients aged 75 years and older with prior myocardial infarction and left ventricular dysfunction (ejection fraction of 30 or less). The authors claim that the results of the trial do not justify this conclusion. The majority of patients were male (84%) and aged 64+/-10 years.

Ethical issues in the management of geriatric cardiac patients.

A 92-year-old patient dies less than a year after aortic valve replacement, pacemaker-AICD implantation, renal dialysis, and rehabilitation at a cost of over a half million dollars.

Ethical issues in the management of geriatric cardiac patients.

A 69-year-old woman dying of severe ischemic cardiomyopathy and peripheral arterial disease is developing gangrene of her toes without pain or overt signs of infection. Should you perform an arteriogram, attempt repeat angioplasty of either or both limbs?