Ethical Aspects of Withdrawing Cardiac Device Therapy at End of Life

Cardiac device therapies are associated with improved survival in patients at risk for sudden cardiac death due to ventricular arrhythmias. The number of implants for both primary and secondary prevention continues to rise both in the United States and European countries. As the population ages and technology advances, patients with implantable devices continue to live longer. When terminal illness becomes apparent, patient’s goals may change to comfort care and painful shocks from ICDs become unwanted and inappropriate. This chapter discusses the challenges that patients and medical caregivers face as these patients deal with terminal illnesses. It also discusses the latest information available in the medical literature related to ethics and patient’s and physician’s attitudes. Ethics will aid the clinician’s management of the goals of care related to potentially complex end-of-life issues. With some pre-planning a potentially stressful situation can become more manageable for all those involved.