Harvard Heart Letter

Choosing options for life-sustaining care

Advance planning will ensure your wishes are followed.

Mr. J. had an implantable cardioverter defibrillator (ICD) for advanced heart failure. Having survived one episode of cardiac arrest, in which he nearly died, he was at high risk for another episode caused by a rapid, unorganized heart rhythm called ventricular fibrillation. Should this happen, the ICD would shock his heart back into normal rhythm. But at his daughter's wedding, the ICD fired nine times. Each time, it saved his life, but the painful episodes terrified him, and he asked that the ICD be turned off.

Dr. Eva Chittenden, associate director of palliative care at Harvard-affiliated Massachusetts General Hospital, met with Mr. J. to explore his decision further. He stated that he had already been hospitalized five times within 12 months, and he felt this took too much time away from his family.

They discussed his personal values and what action he would want taken if his heart stopped, and the ICD was no longer there to revive him.

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