Amara Nwosu


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Implantable cardioverter defibrillator (ICD) deactivation in palliative care – a case involving best interest decisions for someone lacking capacity at the end of life

The use of implantable cardioverter-defibrillators (ICD) has increased due to benefits of preventing death from cardiac arrhythmia. However, the increasing use of ICDs has created new challenges for how to proactively manage deactivation of these devices in people who are dying, especially for those who lack capacity to make decisions about their care. The aim of this case report is to discuss the challenges of planning for deactivation of an ICD for a patient who lacked capacity at the end of life.

In this case report (published on AMRC Open Research) we describe the challenges of managing ICD deactivation in a dying patient with fluctuating capacity who had previously expressed a wish for the ICD to remain active. Although it is preferable to use advance care planning (ACP), to provide care in-line with patient-identified care preferences, we demonstrate how a best interest process can be used to make decisions about ICD deactivation at the end of life.

More information can be found in our case report here:

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Marie Curie cancer Care calls for innovation in approach to how end of life care is delivered

Source: Marie Curie Cancer Care

Marie Curie Cancer Care wants ‘a change in thinking’ about end of life care because the provision of good-quality end of life care varies greatly across the UK and not everybody is getting the level of care and support they need.

A poll, conducted by ComRes for Marie Curie, highlights public confusion and concern about end of life care services, and the different experiences people have.

The Marie Curie have also developed innovative new evidence and data tools to help all service providers, commissioners and policy maker identify gaps in end of life care in their area. This includes a study from the Nuffield trust about the benefits of Marie Curie nurses in the community, and a web based tool to view the state of palliative care in areas across the UK.