Turning Off the Implantable Cardioverter Defibrillator to Prevent Pre-Death Electrical Shocks: An Exercise and Right in the Refusal of Medical Treatment

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There is disagreement between medical professionals about the ethics of ICD (Implantable Cardioverter Defibrillator) deactivation in end of life cases. Deactivation is requested to prevent a patient from feeling ICD-induced shocks (shocks that attempt to restore normal heart beat) at the end of the patient’s life. Some are morally opposed to it while others argue that it is a patient’s right to deactivate it and have a dignified death. Such a disagreement leads to varying approaches that healthcare professionals take when patients want to deactivate their ICDs. Variation inevitably means that some patients will be forced to feel the end-of-life shocks brought on by the ICD. Such shocks, on the surface, depart from the traditional notion of a peaceful and dignified death. Because of the prevalence of heart disease around the world, resolving this ethical dilemma will benefit thousands, if not millions. Without a discussion regarding a potential ethical right to ICD deactivation, millions may be forced to feel end of life shocks.This paper compares the ICD deactivation to active killing, withdrawing treatment, and refusing treatment. Once ICD deactivation is properly labeled in one of these categories, other concerns such as autonomy, pain, and future education are discussed in an effort to resolve the disagreement between medical professionals on this subject and determine if there is an ethical right to deactivation. ICD deactivation fits best under the “withdrawing treatment” category and has similarities with DNRs (Do Not Resuscitate orders). It can also be distinguished from direct killing by looking at the patient’s intentions under the ordinary/extraordinary care distinction. Therefore, it is an ethical right for people to be allowed to deactivate their ICDs at the end of their lives. Autonomy is hindered when one experiences the pains associated with ICDs at the end of life. Autonomy is of paramount importance in ethics and must always be honored. Deactivating ICDs honors this moral norm, while refusing to deactivate trumps this norm. Medical professionals must always respect patients’ wishes and take the necessary actions to give them a peaceful death by deactivating their ICD.