My Sister Doesn’t Want Mom To Get A Pacemaker. What Should I do?

Our mom has some dementia and recently had a fall.  She was told her heart caused it and she needs a pacemaker.  My sister has power of attorney and doesn’t want mom to have the pacemaker.  Our cousins are upset and say she’s letting mom die.  What should we do?

There are several issues here and ultimately all deal with the question of your mom’s quality of life.

First, how severe is your mom’s dementia?  If she is fairly independent and enjoying life, then a pacemaker might help her to live more comfortably for a longer period of time before the dementia really worsens.


However, if she often doesn’t know family members, needs help getting dressed and bathing, and doesn’t appear to really enjoy life, will the pacemaker improve that?  Which begs the question:  with her dementia and now this heart disease, what is her (and your) goal?  Is it quality of time (comfort) or quantity of years (longevity)?

Is the goal to just keep her alive?  Inserting the pacemaker may enable her to live longer, but  that ‘extra’ time also allows the dementia to progress [worsen!]:  increasingly agitated, needing to be in a nursing home, and ultimately resulting in a more miserable and prolonged death.  After discussing these realities, if families are given a choice, most realize such an intervention would NOT be beneficial to either the patient or the family—and refuse the pacemaker.  [for an excellent discussion of this issue, read the NY Times article of June 10, 2010, by Katy Butler: My Father’s Broken Heart: how a pacemaker wrecks a family’s life.

Second, how comprehensive is your sister’s power of attorney (POA), meaning does it include medical decisions?  Although most modern POA’s include a medical authority, not all do—they may be only for financial affairs—so you need to check this.  If there is opposition from others in the family, not having a medical authority can make decisions more difficult, even when you know what the patient wants.

Third, and most importantly, what does your mom want?  Does she have a Living Will (Advance Directive) which describes what kind of care she would want?  Is she able to make decisions right now?  People with mild to moderate dementia can still make medical decisions—even if they are considered incompetent by the court to manage their other affairs.  If she can understand what is being proposed and the alternatives, and the implications for her future, then she can decide—regardless of who had a POA.