Ethics and Religion Talk: May One Allow One's Pacemaker Battery to Die?

From Jim V: There is an elderly patient under hospice care with a pacemaker, stable, not in distress or expected to die in the near future, lucid and oriented cognitively, and ambulatory without aid of a walker or wheel chair. His pacemaker’s battery will need replacement soon. There is no undue risk for him to have the battery replaced. Without a new battery, his heart rate will drop and he will die. Is it morally acceptable for him to refuse to have the pacemaker battery replaced?

The Reverend Colleen Squires, minister at All Souls Community Church of West Michigan, a Unitarian Universalist Congregation, responds:

“For me this is not a question of whether it is morally acceptable to refuse the procedure but rather a question of compassion, respect and understanding on our part. I would imagine losing his independence and losing the quality of life is what worries him more than dying. Most of the elders I know do not want to be dependent at the end of their lives, they want more control over how and when they will die. Unitarian Universalists believe the patient gets to control their care and all health decisions, with their doctor. In my view as difficult as it may seem to some I do believe it is morally acceptable to decline the procedure.”  

The Rev. Rachel J. Bahr, pastor of Plymouth UCC, responds:

“I was a pastor to someone in this situation. Making the decision to upgrade the pacemaker and endure the surgery didn’t make sense to them. They had lived a good and long life. And they would often describe that they would be ready to die when the time came. They weren’t trying to die, in fact they were living from a place of gratitude for the gift of a whole decade beyond. In the United Church of Christ we believe that all life is ‘Good,’ but that doesn’t mean that that it is moral to extend life in all situations. Another important value of our tradition is the importance of an individual's personal autonomy. In this way, I believe that an individual's desire to not prolong their life is justifiable.”

Fred Stella, the Pracharak (Outreach Minister) for the West Michigan Hindu Temple, responds:

“It appears that there might be a great blessing in this situation. If I was given any say in how I could transition from this plane to the next I might borrow from this scenario. I would love to have advance notice so that I could tie up whatever loose ends there might be, have final conversations, etc. Then without taking any direct action that would cause my death, simply allow it to happen. Yes, I would feel very comfortable, ethically speaking, with allowing nature to take its course. While I am sure there are many who are far worse off physically yet passionately holding onto life, Hindu tradition respects the decision of the individual to deny treatment that would extend one’s physical existence as long as nothing is done to cause a death that would be labeled suicide.”

Father Michael Nasser, who writes from an Eastern Christian perspective and is Pastor of St. Nicholas Orthodox Christian Church, responds:

“Although Orthodox Christians remain absolutely opposed to what is called an ‘active euthanasia’--taking steps that lead to one's physical death--we remain dedicated to the literal meaning of the word, a ‘good death.’ Orthodox Christians pray at virtually every service for a ‘Christian ending to our lives: painless, blameless, peaceful and with a good defense before the awesome judgment seat of Christ.’ While it would be inopportune to hasten our time until the end of our earthly life and the judgement which follows, we also believe in our Lord as the conqueror of death and do not believe it is immoral to allow death to come when it comes naturally.”

Rev. Ray Lanning, a retired minister of the Reformed Presbyterian Church of North America, responds:

“Presbyterianism teaches that God’s law (‘Thou shalt not kill,’ Exodus 20:13) requires ‘all careful studies, and lawful endeavors, to preserve the life of ourselves and others,’ including ‘a sober use of physic’ or medicine (Larger Catechism Q. 135). The elderly patient must know that his death is imminent. He is in his right mind, and knows what is to be gained or lost.​ Replacing the pacemaker battery is only a way of extending an already-tenuous lease on life. The decision is entirely his to make, a matter between him and God, and others can only acquiesce in it. Moral courage is required, whether he decides to prolong his remaining time or let things take their course.

“The apostle Paul faces the same question in Philippians 1:19-26: ‘For me to live is Christ, and to die is gain … yet what I shall choose, I wot not. For I am in a strait betwixt two, having a desire to depart, and to be with Christ; which is far better. Nevertheless to abide in the flesh is more needful for you.’ In the end Paul chose to remain in the flesh a while longer to nurture the churches he had planted.”