title: The ethical and legal implications of deactivating an implantable cardioverter-defibrillator in a patient with terminal cancer.
abstract: In this paper, the ethical and legal issues raised by the deactivation of implantable cardioverter-defibrillators (ICDs) in patients with terminal cancer is considered. It is argued that the ICD cannot be well described either as a treatment or as a non-treatment option, and thus raises complex questions regarding how rules governing deactivation should be framed. A new category called "integral devices" is proposed. Integral devices require their own special rules, reflecting their position as a "halfway house" between a form of treatment and a part of the body. The practical problems faced by doctors working in palliative medicine with regard to the deactivation of ICDs are also considered.
authors.affiliation: John Eastwood Hospice, Sutton-in-Ashfield, Nottinghamshire, UK.
authors.forename: Ruth
authors.initials: R
authors.lastname: England
authors.forename: Tim
authors.initials: T
authors.lastname: England
authors.forename: John
authors.initials: J
authors.lastname: Coggon
mesh_terms: D017147:Defibrillators, Implantable / Q000941:ethics*; D026690:Ethics, Clinical; D006801:Humans; D009369:Neoplasms; D013727:Terminal Care / Q000941:ethics* / Q000331:legislation & jurisprudence; D019452:Terminally Ill / Q000331:legislation & jurisprudence; D028761:Withholding Treatment / Q000941:ethics*