The friend within? The implantable cardioverter defibrillator between saving lives and chronically impairing them

Abstract

This article considers the way in which a medical technology, the implantable cardioverter defibrillator (ICD), by preventing fatal outcomes, in this case sudden death, deriving from cardiac diseases, and specifically hypertrophic cardiomyopathy, contributes to the development of a particular type of chronicity. While biomedicine celebrates technological advances in treatments and naturalises chronicity, focussing on life expectancy as a victory over the ‘acute’ aspects of the disease, the way in which patients live with the disease is left unquestioned. The article follows Smith-Morris’s (2010) perspective in seeing chronicity as the never-ending process of identifying with one’s disease, adding a focus on the role played by an embodied technology in relation to it. Based on participant observation in a clinical setting and interviews with clinicians, the article interrogates three key themes in the chronicity of cardiac patients implanted with an ICD: risk, quality of life and choice. The data shows a constant tension between managing a one-off potentially fatal ‘acute’ risk and life with serious disruptions due to the limitations imposed by the implanted device. The article argues that patients’ resources for facing the life and identity disrupted by the disease are limited by ideas of what living a diseased body is, which acritically follow discourses of ‘patient choice’ and a ‘technological imperative’ to avoid risk.

Keywords:

• Chronicity
• medical technologies
• implantable cardioverter defibrillator (ICD)
• risk
• quality of life

Ethical Approval

The research on which this article is based was approved by the competent Ethical Committee for clinical and healthcare research of Central Area, Tuscany Region as ““Medicina Narrativa e Cardiomiopatie genetiche: aspetti psicologici, antropologici e sociali della Relazione tra medico e paziente (MN-CaRe)” [Narrative Medicine and genetic cardiomyopathies: psychological, anthropological and social aspects in the doctor-patient relationship]”. No patient name is mentioned in the article.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was funded by Genzyme; Regione Toscana.