Ethical considerations for discontinuing pacemakers and automatic implantable cardiac defibrillators at the end-of-life.

PURPOSE OF REVIEW As the use of intracardiac devices has increased, the awareness of the burdens of the devices, especially the uncomfortable defibrillator shocks, has also increased. Some patients have requested device deactivation and some physicians have expressed reluctance to do so. This review will update physicians about the ethical acceptability of removal of intracardiac devices. RECENT FINDINGS The American Heart Rhythm Society released a consensus statement about the ethical removal of intracardiac devices. Subsequent surveys of patients and physicians demonstrate significant misunderstandings about deactivation. SUMMARY Physicians ought to initiate a deactivation conversation, ideally at the time of implantation. Sharing case studies about the deactivation process will enable physicians to enhance their ability to guide patients and family through thoughtful decision-making. Guidelines for deactivation should be promulgated throughout institutions that serve patients with intracardiac devices.