When It Comes to Deactivating Pacemakers at the End of Life, Intention Is at the Heart of the Matter

Lisa is a retired (and fictional) social worker and mother of three adult children. For the past year, she has experienced recurrent hospitalizations for behavioral disturbances related to dementia. After each discharge, her family notices she is frailer and more confused. Reflecting on an advance directive Lisa had created five years earlier, her oldest daughter notes that Lisa wouldn’t have wanted life-sustaining therapies if she were so confused that she couldn’t recognize her family.