 Article
|
|
|
|
Services
|
|
|
|
Google Scholar
|
|
|
|
PubMed
|
|
|
|
REPLY
Next-of-Kin Responses and Do-Not-Resuscitate Implications for Implantable Cardioverter Defibrillators
Nathan E. Goldstein, MD;
Rachel Lampert, MD; and
Harlan M. Krumholz, MD
19 April 2005 | Volume 142 Issue 8 | Page 677
IN RESPONSE:
We agree with Morrison and Sinclair that bereaved next of kin may well report the experiences of deceased patients inaccurately. Nevertheless, the perspectives of survivors are important as a first estimate of the experience of patients and as evidence of the impact on family, which is important in its own right. Prospective interviews or observation may well provide other insights, but chart review has substantial limitations in completeness of the data, and after-death review of a defibrillator's memory is uncommon.
As for the issue of what a DNR order means for a patient, our finding of a low rate of discussions about deactivating ICDs in patients with a DNR order is not meant to imply that ICDs "should" be deactivated when a patient or family agrees to a DNR order. Instead, our results call into question why the issue of ICD deactivation was never discussed. We agree with Morrison and Sinclair that conversations about ICDs in patients near the end of life should take place within the much larger context of advance care planning in an effort to help patients weigh the benefits and burdens of various treatments. This will ensure that patients live out their lives in accordance with their wishes.
|
Author and Article Information
|
|---|
 Top
 Author & Article Info
|
|---|
From The Mount Sinai School of Medicine, New York, NY 10029, and Yale University School of Medicine, New Haven, CT 06510.
Potential Financial Conflicts of Interest: None disclosed.
About Letters
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
Related articles in Annals:
-
Articles
Management of Implantable Cardioverter Defibrillators in End-of-Life Care
Nathan E. Goldstein, Rachel Lampert, Elizabeth Bradley, Joanne Lynn, AND Harlan M. Krumholz
- Annals 2004 141: 835-838.
[ABSTRACT][SUMMARY][Full Text]
