help needed soon plz

can some1 plz help answer this questions from this article

1. how it affects the individual (i have got this one, i think)

When Terminal Illness Intervenes, a Cardiac Pacer Can be Deactivated

' Stephen Allen Christensen

Aug 17, 2008

Every patient who has a cardiac pacemaker has wondered: 'Will this thing keep my heart beating if I die for some other reason?'

Nowhere is this question more poignant than in situations where a pacemaker wearer becomes terminally ill. Unfortunately, this eventuality isn't always discussed when a pacemaker is first implanted, and later'when the patient and family members are wrestling with issues of mortality'it can become a ticklish problem.

Issues and Definitions

It isn't unusual for people to be confronted with decisions about life-sustaining measures in the face of terminal disease. Many individuals choose to forego artificial ventilation, feeding tubes, cardiac resuscitation, or even antibiotics and intravenous fluids as their lives draw to an end. Pacemakers, due to the fact that they're usually implanted when patients are relatively healthy, aren't always included in the list of things we call 'artificial life support.'

In broad terms, artificial life support encompasses biomedical technologies that assist or replace a vital function of the body that has been temporarily or permanently damaged. Pacemakers'both legally and ethically'are included within this definition.

However, pacemakers don't necessarily just take over the job of keeping the heart beating. Many pacemakers are on standby much of the time, and they only function when the wearer's rhythm deteriorates in a specific way. Only when the heart cannot sustain life on its own'in cases of complete heart block, for example'does a pacemaker completely supplant the native heart rhythm.

Difficult Decisions

When a patient requests withdrawal of all life support, the degree to which a pacemaker maintains that person's rhythm plays an important role in the decision to deactivate the device. And any pacemaker can be interrogated to determine how much support it is providing, so patients and family members can be told what to expect should that support be removed.

In some cases, a physician may hesitate to turn off a pacemaker that is providing the only stimulus that keeps a patient's heart beating. Indeed, a few cardiologists have demurred from this duty, feeling it was tantamount to homicide. These same doctors, however, would turn off a ventilator or refrain from performing CPR if a patient had made it clear that they wanted no heroic, life-prolonging measures.

The threat of litigation may be the basis for some physicians' hesitation to deactivate a pacemaker. Notably, no doctor has been held liable for discontinuing or withholding life support when patients or their powers of attorney have requested that no such measures be provided.

Once a decision is made to terminate a pacemaker's function, families should be given time to prepare for the death of their loved one'just as would be the case when withdrawing any other form of life support. Everyone involved should understand, too, that deactivating a pacemaker may not necessarily bring life to a sudden end; again, depending on the degree of pacemaker support, some patients may linger for a long time.

The deactivation of a pacemaker is relatively straightforward. Older devices can be deactivated with a magnet. Newer models'those that are magnetically shielded'will require the intervention of a cardiologist or pacemaker technician.

While pacemakers typically only need to be deactivated if they are prolonging the dying process, patients with terminal illness will often want more information--or at least reassurance-- about whether their pacer should be turned off. This contingency should be addressed when a pacemaker is first inserted; thereafter, each time the patient presents for evaluation, this emotionally charged issue should be revisited.