Should implantable cardioverter-defibrillators and permanent pacemakers in patients with terminal illness be deactivated? Deactivating permanent pacemaker in patients with terminalillness. Patient autonomy is paramount.

Cardiovascular implantable electronic devices (CIEDs) are common in the United States as treatment for cardiac rhythm problems. These devices can be lifesustaining. As patients age and suffer from worsening cardiac-related disorders and other terminal illnesses, the electrophysiology community can expect increased requests for device deactivation from patients and their surrogates, creating tension between competing ethical obligations to respect patient autonomy, on the one hand, and to promote patient well being (“beneficence”) and avoid harm (“nonmaleficence”), on the other.