Children >10 years of age were more likely to have structural heart disease. The crude rate of death was 0.78 per 100 000 person-years, and the median interquartile age was 12.7 years, with males accounting for 66% of the cohort. Physical activity at the time of death was also recorded. The 3 patients excluded already had established clinical diagnoses that would explain their deaths. An autopsy was performed in 113 of these cases. Excluding cases with known infectious issues, significant comorbidities, drug overdoses and drowning, or automobile accidents, they found 116 cases. The authors looked at the time period of 2005 to 2009. This is an important study, because nothing like this exists in the United States, which has been a frequent complaint of those who say we underestimate the number of sudden deaths in the United States. 1 They looked at the death investigation system in Ontario, Canada that included coroners who must investigate all deaths that are “sudden, unexpected or from unnatural causes.” A centralized database on these investigations is kept for review. 2 The most recent study of this group was published in 2014 by Pilmer et al. 1 Exactly how uncommon it is varies but is mostly unknown. It is commonly stated that sudden death in the population of patients between 1 to 19 or 21 years of age is uncommon. Moreover, I will attempt to demonstrate that implementing such a policy would be a detriment to our society. When we come to the end of the day, after all the scientific evidence is presented and analyzed, after all the biases and heuristics are explained, the debate between these 2 concepts, utilitarianism versus deontology, is what people vote on when asked, “Do you favor using ECGs to screen the young to prevent SCD?” Nevertheless, I will attempt to persuade you, the reader, that the use of the 12-lead surface ECG is not an acceptable tool to answer this question. For those readers who are Star Trek fans, this is the argument between Spock and Kirk where Spock sacrifices himself, explaining that “the needs of the many outweigh the needs of the few,” and Kirk retorts later, “sometimes the needs of the few outweigh the needs of the many.” So, in Kant’s world, ethical rules bind one to their duty, and, thus, there is an unconditional requirement over all circumstances and the end justifies the means. The hypothetical imperative belies the concept of finding a means to an end, and the categorical says imperative that you act from a sense of duty, a self-given law that is binding for all rational agents.
The central theme here is explained by 2 imperatives-hypothetical and categorical. This line of thinking was promulgated by Immanuel Kant (1724–1804). Deontology, on the other hand, is based on the Greek word todeon meaning duty. The essence of their belief system was the Greatest Happiness Principle or, more plainly speaking, the greatest good for the greatest number of people. Utilitarianism was favored by Jeremy Bentham (1748–1832) and John Stuart Mill (1806–1873) who were consequentialists who believed that whether or not an act is morally right depends on its consequences with respect to utility, thus the term utilitarianism. Two opposing schools of thought-utilitarianism and deontology-are central to this debate. The role of this column is to present the reader with the information that would allow a prudent practitioner to make an informed decision about whether to advocate for universal screening of children and adolescents with an ECG to prevent sudden cardiac death (SCD). Biases and heuristics flavor the decision making and cloud the public policy issues that are central to how we decide what to do and for whom. We have philosophical, ethical, and moral issues surrounding this debate and the 2 types of EBM-evidence-based medicine and emotional-based medicine-as well. No doubt, this is a complex issue at face value. At this time in American history, this quote as it relates to medical spending is appropriate to the debate. Whether or not he actually spoke those words, it is believed that, if he did not, he would have heartily approved having been quoted as such. “A billion here, a billion there and pretty soon you’re talking real money” is a quote attributed to the late Senator Everett Dirksen. Customer Service and Ordering Information.Stroke: Vascular and Interventional Neurology.
Journal of the American Heart Association (JAHA).Circ: Cardiovascular Quality & Outcomes.Arteriosclerosis, Thrombosis, and Vascular Biology (ATVB).
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