To the Editor: We empathize with the challenges faced by Dr Powell in deciding whether her mother, who had dementia and heart block, should receive a pacemaker.1 We would like to clarify some of the misperceptions around pacemaker deactivation conveyed to the author and expressed in the essay, which appear to have complicated the decision-making process.
Most importantly, it is not correct that “they [pacemakers] alone cannot be withdrawn, unlike ventilators, pressors, or any other end-of-life treatment.”1 The Supreme Court has upheld the rights of individuals to refuse or discontinue unwanted life-sustaining therapies. In none of the relevant cases have the courts distinguished between types of life-sustaining treatments. The law applies to the person, and informed consent is a right of the patient (or their health care surrogate): it is not specific to any one medical intervention. Therefore, no treatment, including a pacemaker, has unique ethical or legal status.2