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To the Editor: Dr Rhymes and colleagues¹ agreed that removing a low-burden intervention, such as a pacemaker, from a chronically ill patient is not necessarily unethical. However, the pacemaker of the patient described, Reverend G, is an indwelling device that had arguably become a part of him. It is thereby distinguishable from extrinsic treatments like ventilatory support, hemodialysis, or artificial hydration and nutrition. Thus, acts interfering with pacemaker function would be more akin to killing than to letting die.

We have argued elsewhere that certain medical devices may undergo an ontological metamorphosis, becoming a part of something (or someone) previously distinct.² We have pointed out that precedent for such a transformation can be found in the law of fixtures, a subdivision of property law, and we have termed such devices biofixtures. A fixture is an item of personal property that has been so intimately affixed to a realty that . . . [Full Text of this Article]

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ABSTRACT