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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
- From The Mount Sinai School of Medicine, New York, NY 10029, and Yale University School of Medicine, New Haven, CT 06510.
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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.
Nathan E. Goldstein, MD
The Mount Sinai School of Medicine; New York, NY 10029
Rachel Lampert, MD
Harlan M. Krumholz, MD
Yale University School of Medicine; New Haven, CT 06510
Article and Author Information
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Potential Financial Conflicts of Interest: None disclosed.
