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


This paper offers a more comprehensive account of the ethical issues associated with the implantation, maintenance, deactivation, removal, and reuse of pacemakers than has been available to date. While one issue—the deactivation of pacemakers during end of life care—has been the subject of considerable reflection in the literature, the others are relatively neglected. The evolution of pacemakers has given rise to new ethical issues, such as risks to patient privacy and risk of harm from hackers. Other issues that should be attracting greater interest and concern from practitioners include: the potential for conflicts of interest to arise, particularly for IEAPs; unanticipated impacts of commercial competition and the continuing cycle of device improvement; challenges to the equitable provision of best practice cardiac rhythm management; and ethical considerations associated with the re-use of explanted pacemakers. Cardiologists should be aware of all of these issues. We have provided tables summarising some key questions clinicians might use to guide reflection on these issues in the context of patient care and device selection. Cardiologists also have an important perspective to bring to ongoing discussions about how they are resolved.