ICD Deactivation End of Life — EECC MCQ

Correct answer: E — ICD deactivation should be discussed proactively as part of advance care planning — delivering shocks during the dying process causes distressing pain without meaningful benefit; the patient (or their healthcare proxy) has the right to request deactivation, and this is an ethically supported clinical decision

ICD deactivation in the terminal/end-of-life setting is an important but often neglected aspect of care. The ESC 2022 VA/SCD Guidelines and multiple ethical position statements: (1) ICD shocks at end of life cause significant suffering without therapeutic benefit — they do not treat the underlying disease and merely prolong the dying process; (2) proactive discussion of ICD deactivation is recommended as part of advance care planning (Class I); (3) ICD deactivation is ethically supported — it is NOT euthanasia (the device is withdrawn, not a lethal agent administered; the patient dies from their underlying condition); (4) the patient (or healthcare proxy with lasting power of attorney) has the RIGHT to request deactivation at any time; (5) deactivation involves programming off the shock therapies (tachyarrhythmia detection OFF); bradycardia pacing can be left active if desired; (6) this discussion should occur BEFORE the crisis phase (ideally at ICD implant, certainly when prognosis is limited).

Reference: ESC (2022): VA/SCD Guidelines; EHRA Consensus on ICD Deactivation