Has anyone requested a pacemaker be turned off?

I don't think it's depression, I think it's the dementia. She simply has stopped initiating any conversation. If I ask her a question or make a comment she will happily respond. But it's like on her own she doesn't know what to say.

A pacemaker's function is to assist the heart in performing its job easier or in the case of Atrial Fibrillation, to help the heart rate stay regular and within a specific rate but it DOES NOT prolong life. The pacemaker requires the heart to be able to respond to the electrical impulses the pacemaker battery sends to the heart muscles.  A person can “die” but their heart continue to attempt to respond to the electrical impulses being sent by the pacemaker resulting in the person having a pulse until the pacemaker is turned off. 

I had a friend whose grandfather had a pacemaker. The grandfather was 102 years old and had a very irregular heartrate that varied from 82 to 120 beats per minute. When he “died”, his heart rate stopped being irregular at 11:30 AM, however, he had a pulse (which was very regular and matched the pulse rate set on the pacemaker) until 1 PM when the doctor turned off the grandfather’s pacemaker.

Do pacemakers work even after death? See the article posted by Science Illustrated on February 27, 2012:on scienceillustrated.com.au/blog/medicine/ask-us-will-pacemakers-still-work-after-death/ which gives a good explanation of how the pacemaker works when someone dies.  I hope that this helps answer some of your questions.

I understand a person can die while they still have a pacemaker. But I don't understand how it can be said that it doesn't prolong life. If my mom didn't get her pacemaker eight years ago I assume her heart would have slowed down until she died. To me, that's prolonging life.

What I don't know and would be interested in hearing more about is whether a pacemaker could stop you dying if you're going to die. If it *always* prolongs life to a greater or lesser extent.

Your mother's pacemaker supporting her heart function is one thing - it's maintaining function. But if, God forbid, for example, she had had an infarction the pacemaker couldn't have stopped it.

Or. The pacemaker maintains electrical activity and keeps contractions going. But if the valves of the heart don't close, or if the muscle of the heart weakens beyond a certain point, the heart will cease to function as a blood pump. The pacemaker will not prolong life.

Normally I'm very interested in learning more about things but I'd rather stop thinking about it for now.

[Sorry, DeeAnna, I've only just seen your links which I will look forward to visiting another time - thank you]

My dad had a pacemaker with a defibrillator. When he entered hospice I had to call for them to disable the defibrillator as would have shocked his heart when he was dying. They came to the house and ran a magnet over the pacemaker that deactivated the defibrillator. It was a very simple process but was extremely difficult for me since it was something I had to do actively as part of his death. They assured me the pacemaker would make no difference in how he died. I've often wondered since then, though, as the pacemaker kept his heart beating steadily until the end. I guess I will never know if it made a difference or not.

My experience was this. Dad had a pacemaker/defibrillator. If nothing was done, then the process of dying would be painful since the defibrillator would activate multiple times (like getting regularly kicked in the chest). Luckily, his generator needed replacing when we knew his condition wasn't anywhere near as good as when it was implanted. We chose to replace it with a standard pacemaker. His cardiologist was not of the opinion that his simple pacemaker should be disarmed if his condition deteriorated. When he passed under his particular circumstances the pacemaker was not an issue. My mother had a pacemaker (in fact four over the span of 22 years) without which she would have died long ago. When she went onto hospice, I discussed her pacemaker with the intake nurse who stated that they do not turn off simple pacemakers. When, mom passed, her pacemaker didn't cause a problem. So in one case a cardiologist said no and in another case a hospice nurse the answer said no. The only yes was to disarm a defibrillator which is most easily done at the cardiologist's office. Perhaps, the feeling is that disarming a pacemaker is too active an action to end the person's life? You say that the pacemaker is 8 yrs old. If you loved one is bedridden and their resting heart rate is naturally very slow, then the pacemaker may be used most of the time every day and that battery will be losing strength. The reduction of battery life isn't a gentle slope; it stays fairly level, then drops off a lot more precipitously near the end. It sounds like a good discussion would be about not replacing the generator when the time comes.

Msweeney, you are right in stating that the pacemaker “prolonged” your mother’s life. If your mom had not gotten a pacemaker eight years ago, she would have died much sooner, maybe 5-6 years ago because, as you stated: “her heart…would have slowed down and eventually stopped. Nature taking its course.” If your mom had not gotten a pacemaker, you most likely would not have experienced the past eight “good” years with your mother. You might have experienced/enjoyed only two or three “good” years with your mom instead of eight “good” years.

Earlier you stated that the pacemaker:
“was a good decision, she was healthy, active, it gave her several good years. Fast forward to today, she has dementia (worsening quickly...usually thinks I’m her mother), she’s blind, has breast cancer, COPD, can barely walk, incontinent, and suffers from anxiety.” Msweeney, are you regretting that your mother got a pacemaker eight years ago because your mom now has so many health problems?

Please forgive me for asking such a personal question, but I think that it is something you need to consider. I get the feeling that you are angry that your mom is so sick and that you are blaming the pacemaker for her many health problems. We all get angry when our parent’s health starts to decline or worsen. We all want our parents to be the healthy persons they used to be. Unfortunately, “LIFE” doesn’t work that way. We all get sick and we all die. Sorry if I have added to your misery or emotional pain.

Countrymouse, I agree with you...I'd rather stop thinking about it for now.
This is a very personal and emotional subject that we are discussing. Unfortunately, it won't get any easier to talk about or think about for quite some time.

Msweeney, God is HOPE (Romans 15:13) -- God is COMFORT (II Corinthians 1:15) -- God is WITH YOU (Isaiah 41:10) I am praying for you with faith, hope, and loving care. DeeAnna

DeeAnna, you've given me some food for thought. I don't regret getting her the pacemaker, I believe it gave her some quality years of life. But maybe I am blaming the pacemaker now for keeping her heart steady as the rest of her disintegrates. I definitely have some anger, mostly towards the unfairness of it all. I'll have to work through that part on my own.

I appreciate the scriptures, I do have faith, especially in the resurrection (Acts 24:15). That's what makes it hard, some days I just pray that she falls asleep in death because I believe she's better off in that state than how she's living now.

Thank you all for your comments and kind words, this discussion has given me a lot to think about.

My father had his defibrillator turned off. It was his choice and his doctor followed his orders. Dad passed away on February 2, 2017 and it had nothing to do with his device. I think he was afraid of what he would go through if the device fired. The doctor explained it to us and it was horrifying to know what happens to a person when the device actually fires.

MSweeney- my mother is 88. Her pacemaker was put in 4 years ago. I am understanding where you are coming from- re the dementia and various health problems. Sitting there with eyes closed, not initiating any conversation- only able to lie there some days, bowel issues etc. so depressing to watch this slow and grueling decline. Tomorrow we go to our cardiologist where they will tell us how much battery life is left etc. I am sure this has prolonged my mother s life, which helped for a couple of years until Parkinsons and dementia kicked in. She really has very low quality of life at this point. And when the battery is needing to be replaced and they want to go in and put another one in, her wishes are quite clear that it won't be happening. The ICD Pacer is the one that shocks or defibrillates the heart. You can request that one to have the defibrillator in it turned off to avoid that shocking/kicking feeling that would occur at the end. My mother has the one for a slow pulse. I'm not sure if it would continually try to kick in if she were to be actively dying. Going to ask! Take care

Mom had a pacer/defib, so it had to be turned off, otherwise the defib would have kept trying to restart her heart. There were no issues when I asked for it to be turned off.

Dear M Sweeney...I am sending strength, comfort and kindness to you and your Mom as all these health and care issues are a lot for both of you. My Mother had COPD, anxiety/depression issues and Congestive Heart failure and dementia and some other things. She was not happy living without her freedom and had signed a Do Not Resuscitate form and I was her POA so we spoke to her cardiologist and had her pacemaker turned off. She was not in pain after but ate littlenot related to pacemaker turn off) and died a short time after in her sleep.  I was under the assumption that the pacemaker was prolonging her life. The Doctor should be able to better advise you. Since your Mother was clear that she would want to only live with a good quality of life and no extreme measures then you should feel no guilt about following this path if it will help her die naturally without pain. I wish there were an easier path to end of life decisions and I hope you have a good support system. I think you are following a brave and compassionate path and I hope the cardiologist is very helpful and compassionate to you and your Mom.

Lala17,
Thank you for your kind words. Interesting that you had a compassionate cardiologist who agreed to turn off your mother’s pacemaker. I’m sorry for your loss but happy to hear she went peacefully in her sleep. Did she have the defibrillator type?

When I brought it up at her pacemaker check the cardiologist could not shoot me down fast enough. He said all it would do is make her a fall risk. He told me that we didn’t have to replace the battery, which has about 4 to 5 years left. He could not get out of the room fast enough, to be honest.

Another poster had recommended the book “Knocking on Heavens Door” so I read it and it was very good. I could completely relate to the author’s position and feelings of helplessness as she saw her father deteriorate to just a shell of a person while his pacemaker kept his heartbeat steady....

Unfortunately it’s looking as though keeping my mother at home is not going to be realistic much longer. I just physically can’t do it. So instead of a peaceful death at home in her bed I’m afraid it will be a long drawn out life of suffering in a nursing home. It’s breaking my heart.

Why do you think that your Mom's life is going to be so much longer and "worse" in the nursing home, then if she was at home?. Her health isn't going to change (except for the natural progression of her diseases/illnesses) when she goes into the nursing home. What is changing is where your Mom is sleeping and eating. Your Mom could have "a long drawn out life of suffering" at home also. And she can also have "a peaceful death" while living in the nursing home.

Yes, it's breaking your heart, but maybe not for the reason that you have stated. It is breaking your heart, because you will no longer be the person taking care of your Mom. Strangers, "professional caregivers", will be taking care of your Mom--and that hurts a lot. It also hurts because you will not be with your Mom 24 hours/day anymore.

Please give the nursing home a chance. Let the nursing staff show you just how loving thy can be towards your Mom. You might be surprised.

From Scienceillustrated.com (the link given above)
...the heart can easily stop beating in spite of the pacemaker still emitting electrical impulses. And if the heart tires over the years and no longer has the power to contract, or if a coronary thrombosis (blood clot) occurs, the pacemaker is of no help.

I guess this is a touchy subject.
In my opinion, an artificial device implanted in a body, is a foreign object ("artificial means"). Implanting it gives the person more years to live. Turning it off or taking it out can change the heart functioning, possibly causing a cardiac change that could end in death.

The difficult part is some people would think you'd be playing God by turning it off. The same thing if you removed a feeding tube, stopped life saving medication or turned off a ventilator. Some would think she's "not bad enough" for intervention yet.

I don't believe that it's humane to keep a suffering person alive artificially, if there is no chance of recovery. You believe she is suffering and has no quality of life.
I don't believe that you want to be rid of your mom and the constraints of her diseases. It sounds like you are trying to comply with your mother's wishes. This is a personal issue, with no right or wrong answers.

I doubt you'd find many cardiologists that would turn off a pacer. I'm sure they're worried about being sued when the patient dies and the family member that wanted it off has changed their mind.

I'm sorry your mom may have to go into a NH. I had to place my mother also because I was no longer able to lift and reposition her. Life doesn't always go the way we plan it.