Devices Can Interfere With Peaceful Death

More than 500,000 Americans -- including Vice President Cheney -- have the devices, known as implantable cardioverter defibrillators, or ICDs, and the number getting them has been rising rapidly. At least 150,000 new ones are implanted annually. An additional 4 million patients are medically eligible for one.

The battery-operated devices, about the size of a pager, are implanted under the skin below the collarbone with wires running into the heart to monitor its electrical rhythm and deliver powerful shocks if it becomes dangerously fast or chaotic. As the first patients to receive the devices have started dying in significant numbers, concern about their downside has grown.

"This is becoming more apparent now as large numbers of baby boomers are coming into hospice age and starting to show up with these devices," said Walter Forman, a geriatrics expert at the University of New Mexico Health Sciences Center.

The devices, Forman and others said, can make the difficult process of dying even more arduous.

Helen Fryear, 64, of St. Petersburg, Fla., brought her husband home to die peacefully in his bed. But she watched helplessly in the middle of the night as his ICD shocked him more than 30 times.

"There's no word to describe it. It was horrible," Fryear said. "The only thing I could do was just hold him and keep telling him that I loved him and he wasn't alone until it finally stopped."

Aside from making the moment of death more painful for patients and traumatic for family, the devices can prolong suffering, especially for heart patients.

"They are short of breath, getting weaker and weaker. They feel like they are drowning," said Lynne Warner Stevenson, a Harvard Medical School heart specialist. "For them, these devices can convert a rapid death to a slow and miserable death."

Large, specialized doughnut-shaped magnets can disable ICDs in an emergency. And programming devices can permanently deactivate ICDs wirelessly. But often ICDs are not switched off, for a mix of reasons that reflect the fragmented medical system, the complex emotions and fears about dying, and sometimes just the difficulty of finding someone to do it.

Patients, families and doctors often simply forget to disarm the devices, even when they have decided to forgo other treatment.

"When you walk into the room and see a ventilator or a dialysis machine, that's a big reminder to talk about it. With defibrillators, it's small, it's internal. A lot of time we just don't think about it," said Nathan Goldstein, an assistant professor of medicine and geriatrics at Mount Sinai School of Medicine in New York.

Part of the problem, some experts say, is that ICDs are being implanted too often, sometimes when patients are already close to death or when the devices are likely to do more harm than good. Even patients for whom the devices are appropriate can find themselves dying of other causes, such as cancer, and might have lost contact with the heart specialists who are most likely to remember to raise the issue.