title: Ethical and legal perspective of implantable cardioverter defibrillator deactivation or implantable cardioverter defibrillator generator replacement in the elderly.
abstract: OBJECTIVE
  Implantable cardioverter defibrillator (ICD) implantation has become a common and standard treatment for primary and secondary prevention of sudden cardiac death in patients with poor left ventricular ejection fraction across the world. Circumstances, of course, change after the initial implant as patients age. This raises legal and ethical questions about deactivating or not replacing ICD generators when the likelihood of meaningful benefit has diminished.
  
  
  RESULTS
  Health professionals are reluctant to discuss the end-of-life planning with patients who have ICDs. Older patients are more likely to have multiple comorbidities that worsen or accumulate further after initial implantation and attenuate the survival benefit of ICDs. Joint guidelines suggest physicians educate patients during the initial consent process about the possibility of deactivating ICDs after implantation if their individual situation changes to the point of futility.
  
  
  CONCLUSIONS
  ICD deactivation and nonreplacement are unavoidable issues that require clarity for meaningful and ethical implementation. This is an ongoing process.
authors.affiliation: Division of Cardiology, University of Western Ontario, London, Ontario, Canada.
authors.forename: Gary A
authors.initials: GA
authors.lastname: Wright
authors.forename: George J
authors.initials: GJ
authors.lastname: Klein
authors.forename: Lorne J
authors.initials: LJ
authors.lastname: Gula
mesh_terms: D032722:Advance Care Planning / Q000941:ethics; D022561:Advanced Cardiac Life Support / Q000941:ethics / Q000295:instrumentation / Q000379:methods; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016757:Death, Sudden, Cardiac / Q000209:etiology / Q000517:prevention & control; D017147:Defibrillators, Implantable / Q000941:ethics*; D006299:Health Services for the Aged / Q000592:standards; D006801:Humans; D013727:Terminal Care / Q000941:ethics / Q000331:legislation & jurisprudence; D018487:Ventricular Dysfunction, Left / Q000150:complications*