Internal Defibrillators at End of Life

By: Grace Blanchard RN, CHPN

According to the American Heart Association, more than 140,000 implantable cardioverter defibrillators (ICDs) are placed each year. There is no question that these devices can be life-sustaining for the majority of these patients. The question is whether these devices should be deactivated when a patient has been diagnosed with a terminal disease. In a Boston Globe article published this past March, Dr. Daniela J. Lamas wrote, “…when someone is dying from an irreversible disease like cancer, the defibrillator’s shocks to a failing heart might only serve to postpone death.”

Many people who’ve had a defibrillator fire report the experience is very painful. A family member touching the patient whose device is firing is also at risk to be shocked. So, when considering comfort measures at the end of a person’s life, it’s important to talk about deactivation.

I‘ve found that many patients and families don’t understand the difference between a pacemaker and a defibrillator. I have never personally known a hospice patient to have a pacemaker deactivated. When I talk to families, I tell them that an internal defibrillator delivers a high-energy shock. I explain it’s similar to the shock delivered by the external defibrillator paddles EMTs use when trying to resuscitate a patient whose heart has stopped. I have very detailed conversations with families about what a resuscitation attempt would be like for a terminally ill patient. For those who choose DNR status, deactivation of the ICD is consistent with that choice.

Hospice care is dedicated to patient self-determination and autonomy. Educating patients and families about the burden versus benefits of any treatment, and exploring their goals and wishes about their own unique circumstances, is the best way to provide a good death experience for everyone involved.



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