Lifesaving implants complicate end-of-life care

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More than a decade has passed, but Nathan Goldstein, then a medical resident at Mount Sinai Hospital in New York City, still remembers it clearly.

A man with terminal lung cancer had planned to die at home with hospice care. Instead, the man was lying on a stretcher in the busy emergency room. Every few minutes, his heart received a shock from his internal defibrillator, preventing his heart from stopping.

The implantable cardioverter defibrillator, or ICD, can be a lifesaving device when its charge of electricity jolts the heart out of a potentially lethal rhythm. But when someone is dying from an irreversible disease like cancer, the defribillator’s shocks to a failing heart might only serve topostpone death.

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