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ICD Deactivation Ethics — RACP Adult Medicine MCQ

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ModerateGeriatric MedicineICD Deactivation EthicsRACP Adult Medicine

A 55-year-old man with a known cardiac implantable device (ICD) is approaching end of life with metastatic lung cancer. He asks about ICD deactivation. What is the ethical and clinical framework for ICD deactivation at end of life?

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Correct answer: C — ICD deactivation constitutes euthanasia

ICD deactivation at end of life is ethically permissible and is recommended as part of proactive advance care planning discussions. Continuing ICD therapy in a dying patient can cause distressing shocks during the natural dying process. The Heart Foundation of Australia and Palliative Care Australia support ICD deactivation when it aligns with the patient's goals of care. A magnet placed over the ICD can temporarily inhibit shock therapy. Formal reprogramming by a cardiac physiologist/electrophysiologist is needed for permanent deactivation. ICD deactivation does NOT constitute euthanasia – it is withdrawal of a treatment the patient has chosen to decline.

Reference: NHF – 2024 – ICD Deactivation Position Statement; Palliative Care Australia – 2023