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ICD Deactivation Palliation — RACP Adult Medicine MCQ

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ModerateCardiologyICD Deactivation PalliationRACP Adult Medicine

A 80-year-old man with an ICD develops end-stage lung cancer with an estimated survival of 2 weeks. He is receiving palliative care. He receives an ICD shock for VT while resting comfortably. The shock is distressing. His family asks about deactivating the ICD. What is the most appropriate management?

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Correct answer: A — Deactivate ICD defibrillation function after informed discussion

In end-of-life care, ICD shocks cause significant distress without meaningful benefit. Deactivation of defibrillation therapy (shock function off) is ethically appropriate after informed discussion with patient/family/substitute decision-maker. Pacing function can be maintained if providing symptomatic benefit (e.g., for bradycardia). This is NOT euthanasia — it is withdrawal of a medical treatment that is no longer providing benefit. All palliative care patients with ICDs should have advance care planning discussions about device deactivation.

Reference: PCA – 2024 – ICD Deactivation; NHFA 2024 Advanced Heart Failure