Medicolegal issues arising when pacemaker and implantable cardioverter defibrillator devices are deactivated in terminally ill patients

Abstract

The number of patients receiving pacemakers and implantable cardioverter defibrillator (ICD) devices continues to increase dramatically. In this paper, the issue of when it is appropriate to deactivate these devices if the patient becomes terminally ill and the medicolegal implications of this action are examined. This appears to constitute a withdrawal of treatment. However, the issue has never come before the courts and therefore no medicolegal guidance exists on the point. This paper highlights a lack of knowledge among health-care staff regarding switching off electromechanical devices in terminally ill patients. We propose some guidance and recommendations for dealing with this issue when it arises in practice, and highlight some important differences between pacemakers and ICDs that will influence decision-making. Conclusions are expressed regarding how this issue should be dealt with in the postmortem setting and in the antemortem setting, where the issue of capacity and consent will influence decisions regarding deactivating these devices.