Ethics and the Cardiac Pacemaker: More Than Just End-of-life Issues

Katrina Hutchison; Robert Sparrow


Europace. 2018;20(5):739-746. 

In This Article

Conflicts of Interest

Although partnerships between clinicians and industry facilitate the development and improvement of pacemakers, the potential for conflicts of interest to arise in these relationships is widely acknowledged. The risks of conflicts of interest that arise in interactions with IEAPs have received less attention, despite their often significant role in the care of patients with pacemakers.

Clinician Conflicts of Interest

Clinician conflicts of interest have been a subject of concern across clinical specialisations for some time. In the past, pacemakers have been at the centre of specific investigations.[19] The resulting regulatory changes ensure improved transparency and oversight insofar as clinicians remain involved in processes of pacemaker improvement and innovation, activities that can attract financial benefit and esteem.

However, research into conflicts of interests suggests that even casual interactions between industry representatives and clinicians are associated with changes in prescribing patterns.[20,21] Given the extent and nature of interactions between cardiologists and representatives of companies that manufacture and sell pacemakers, there is a clear danger of conflicts of interest.

In response to this concern, it has been argued by leading cardiologists that clinicians with high professional standards who intend to provide the best possible care to individual patients are thereby protected from conflicts of interest.[22] Unfortunately, however, these admirable commitments are no guarantee against conflicts of interest for two reasons.

First, physicians are often unaware of conflicts of interest where they exist: nor does consciousness of a potential conflict of interest guarantee that it exerts no influence on a clinician's decisions.[23]

Secondly, the harms associated with conflicts of interests are not limited to specific harms to individual patients that arise from conflicted treatment decisions. A relationship that gives rise to a conflict is harmful partly because it is not possible to determine its impact on decision-making.[24] Perception by the community that clinicians are conflicted is also harmful, as it can undermine patient trust in individual clinicians and the healthcare system.