title: Ethical considerations for turning off pacemakers and defibrillators.
abstract: The 2010 guidelines regarding management of cardiovascular implantable electronic devices (CIEDs) conclude that patient requests to deactivate these devices at the end of life should be honored. Nevertheless, many clinicians and patients report feeling uncomfortable discontinuing such therapies, particularly pacemakers. If the principles of clinical ethics are followed, turning off CIEDs at the end of life is morally permissible. Clinicians managing CIEDs should discuss the option of deactivation with the patient at the time of implantation and be prepared to reopen the question as warranted by the patient's clinical course and respect for the patient's authentic values.
authors: Department of Medicine, The University of Chicago Medicine, 5841 South Maryland Avenue, Chicago, IL 60637, USA.
authors: Kyle E
authors: KE
authors: Karches
authors: Department of Medicine and Divinity School, The University of Chicago Medicine, University of Chicago, 5841 South Maryland Avenue, Chicago, IL 60637, USA. Electronic address: dsulmasy@medicine.bsd.uchicago.edu.
authors: Daniel P
authors: DP
authors: Sulmasy
mesh_terms: D001291:Attitude of Health Personnel; D017147:Defibrillators, Implantable / Q000941:ethics*; D006801:Humans; D010138:Pacemaker, Artificial / Q000941:ethics*; D010817:Physician-Patient Relations; D013727:Terminal Care / Q000941:ethics*
keywords: CIED deactivation; Physician-patient communication; Substitutive versus replacement therapy