Should implantable cardioverter-defibrillators and permanent pacemakers in patients with terminal illness be deactivated?: An Ethical Distinction
Abstract
Therapy of Cardiac Rhythm Abnormalities 1 include a discussion of ethical issues surrounding the deactivation of pacemakers, implanted cardioverter-defibrillator (ICDs), and CRT devices in patients who are terminally ill.The authors rightly note that most clinicians make an ethical distinction between deactivating an ICD and deactivating a permanent pacemaker.3][4][5][6][7][8] Many patients and physicians find the deactivation of an ICD in this situation as morally equivalent to a "do not resuscitate" order.Deactivation of an ICD in a patient who is dying of a terminal illness, whether cardiac or another condition, prevents the delivery of painful ICD shocks and allows the patient to die of the natural progression of their underlying disease.As such, this action seems a humane withdrawal of a futile medical treatment.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Although most physicians are comfortable with the deactivation of an ICD, some describe less comfort with PM deactivation, particularly in PM-dependent patients.
“Although most physicians are comfortable with the deactivation of an ICD, some describe less comfort with PM deactivation, particularly in PM-dependent patients. 36,37”
From Managing with pacemakers and implantable cardioverter defibrillators (2013) · cites this paper as [37]
Cites
ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities
Epstein, A. E., Dimarco, J., Ellenbogen, K. A., Estes, N. A. M., Freedman, R. A., Gettes, L. S., Gillinov, A. M., Gregoratos, G., Hammill, S. C., Hayes, D. L., et al. (2008) · Circulation · doi:10.1161/circualtionaha.108.189742 · Cited by 1,768 · see citing works
Stöllberger, C., Pfersmann, V., & Finsterer, J. (2009) · Heart Rhythm · doi:10.1016/j.hrthm.2009.01.020 · Cited by 222 · see citing works
Mueller, P. S., Hook, C. C., & Hayes, D. L. (2003) · Mayo Clinic Proceedings · doi:10.4065/78.8.959 · Cited by 120 · see citing works
Withdrawing Implantable Defibrillator Shock Therapy in Terminally Ill Patients
Lewis, W. R., Luebke, D. L., Johnson, N. J., Harrington, M., Costantini, O., & Aulisio, M. P. (2006) · The American Journal of Medicine · doi:10.1016/j.amjmed.2006.01.017 · Cited by 100 · see citing works
Within You / Without You: Biotechnology, Ontology, and Ethics
Sulmasy, D. P. (2007) · Journal of General Internal Medicine · doi:10.1007/s11606-007-0326-x · Cited by 84 · see citing works
The Ethics of Deactivating Implanted Cardioverter Defibrillators
Berger, J. T. (2005) · Annals of Internal Medicine · doi:10.7326/0003-4819-142-8-200504190-00012 · Cited by 81 · see citing works
Berger, J. T., Gorski, M., & Cohen, T. J. (2006) · The Journal of Clinical Ethics · doi:10.1086/jce200617109 · Cited by 40 · see citing works
England, R., England, T. J., & Coggon, J. (2007) · Journal of Medical Ethics · doi:10.1136/jme.2006.017657 · Cited by 35 · see citing works
Deactivating the Implantable Cardioverter-Defibrillator
PAOLA, F. A., & Walker, R. (2000) · Southern Medical Journal · doi:10.1097/00007611-200093010-00003 · Cited by 35 · see citing works
Deactivating the implantable cardioverter-defibrillator: a biofixture analysis.
Paola, F. A., & Walker, R. (2000) · PubMed · Cited by 33 · see citing works
The ethics of implantable devices
Wu, E. B. (2007) · Journal of Medical Ethics · doi:10.1136/jme.2006.019000 · Cited by 24 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Lampert, R., Hayes, D. L., Annas, G. J., Farley, M. A., Goldstein, N. E., Hamilton, R. M., Kay, G. N., Kramer, D. B., Mueller, P. S., Padeletti, L., et al. (2010) · Heart Rhythm · doi:10.1016/j.hrthm.2010.04.033 · Cited by 434 · see citing works
Self-citationPadeletti, L., Arnar, D. O., Boncinelli, L., Brachman, J., Camm, A. J., Daubert, J., Kassam, S., Deliëns, L., Glikson, M., Hayes, D. L., et al. (2010) · EP Europace · doi:10.1093/europace/euq275 · Cited by 379 · see citing works
Kramer, D. B., Kesselheim, A. S., Brock, D. W., & Maisel, W. H. (2010) · Heart Rhythm · doi:10.1016/j.hrthm.2010.07.018 · Cited by 77 · see citing works
Heart Failure Management in Skilled Nursing Facilities
Jurgens, C. Y., Goodlin, S. J., Dolansky, M. A., Ahmed, A., Fonarow, G. C., Boxer, R. S., Arena, R. A., Blank, L., Buck, H. G., Cranmer, K. W., et al. (2015) · Circulation Heart Failure · doi:10.1161/hhf.0000000000000005 · Cited by 63 · see citing works
Kapa, S., Mueller, P. S., Hayes, D. L., & Asirvatham, S. J. (2010) · Mayo Clinic Proceedings · doi:10.4065/mcp.2010.0431 · Cited by 62 · see citing works
Managing with pacemakers and implantable cardioverter defibrillators
Lampert, R. (2013) · Circulation · doi:10.1161/circulationaha.113.001555 · Cited by 34 · see citing works
Heart Failure Management in Skilled Nursing Facilities
Jurgens, C. Y., Goodlin, S. J., Dolansky, M. A., Ahmed, A., Fonarow, G. C., Boxer, R. S., Arena, R. A., Blank, L., Buck, H. G., Cranmer, K. W., et al. (2015) · Journal of Cardiac Failure · doi:10.1016/j.cardfail.2015.02.007 · Cited by 34 · see citing works
Deactivation of Pacemakers and Implantable Cardioverter-Defibrillators
Kramer, D. B., Mitchell, S. L., & Brock, D. W. (2012) · Progress in Cardiovascular Diseases · doi:10.1016/j.pcad.2012.09.003 · Cited by 32 · see citing works
Pacemaker deactivation: withdrawal of support or active ending of life?
Huddle, T. S., & Bailey, F. A. (2012) · Metamedicine · doi:10.1007/s11017-012-9213-5 · Cited by 29 · see citing works
Implantable Cardioverter–Defibrillator Use in Older Adults
Kramer, D. B., Matlock, D. D., Buxton, A. E., Goldstein, N. E., Goodwin, C., Green, A. R., Kirkpatrick, J. N., Knoepke, C. E., Lampert, R. J., Mueller, P. S., et al. (2015) · Circulation Cardiovascular Quality and Outcomes · doi:10.1161/circoutcomes.114.001660 · Cited by 26 · see citing works
Ethics Considerations for Medical Device R&D
Citron, P. (2012) · Progress in Cardiovascular Diseases · doi:10.1016/j.pcad.2012.08.004 · Cited by 23 · see citing works
The Deactivation of Implantable Cardioverter-Defibrillators
Carlsson, J., Paul, N. W., Dann, M., Neuzner, J., & Pfeiffer, D. (2012) · Deutsches Ärzteblatt international · doi:10.3238/arztebl.2012.0535 · Cited by 21 · see citing works
Ventricular Arrhythmias in Patients With Implanted Defibrillators
Stevenson, W. G., & John, R. M. (2011) · Circulation · doi:10.1161/circulationaha.111.064816 · Cited by 19 · see citing works
Niewald, A., Broxterman, J. T., Rosell, T. D., & Rigler, S. K. (2012) · Journal of Medical Ethics · doi:10.1136/medethics-2012-100613 · Cited by 18 · see citing works
Quality of Life and End-Of-Life Issues for Older Patients with Implanted Cardiac Rhythm Devices
Lampert, R. J. (2012) · Clinics in Geriatric Medicine · doi:10.1016/j.cger.2012.07.005 · Cited by 12 · see citing works
Ethical Considerations for Turning off Pacemakers and Defibrillators
Karches, K. E., & Sulmasy, D. P. (2015) · Cardiac Electrophysiology Clinics · doi:10.1016/j.ccep.2015.05.012 · Cited by 13 · see citing works
Physicians' knowledge of implantable defibrillator treatment: are we good enough?
Westerdahl, A. K., & Frykman, V. (2017) · EP Europace · doi:10.1093/europace/euw228 · Cited by 12 · see citing works
Is Pacemaker Deactivation at the End of Life Unique?: A Case Study and Ethical Analysis
Whitlock, S. N., Goldberg, I. P., & Singh, J. P. (2011) · Journal of Palliative Medicine · doi:10.1089/jpm.2011.0084 · Cited by 11 · see citing works
An Approach to Caring for Patients and Family of Patients Dying in the ICU
Jennerich, A. L. (2024) · CHEST Journal · doi:10.1016/j.chest.2024.02.007 · Cited by 10 · see citing works
Svanholm, J., Nielsen, J. C., Mortensen, P. T., Christensen, C. F., & Birkelund, R. (2015) · Pacing and Clinical Electrophysiology · doi:10.1111/pace.12702 · Cited by 9 · see citing works
Der chronisch kritisch kranke Patient aus der Perspektive des Kardiologen
Janssens, U., & Reith, S. (2013) · Medizinische Klinik - Intensivmedizin und Notfallmedizin · doi:10.1007/s00063-012-0193-z · Cited by 8 · see citing works
Resisting the hospice narrative in pursuit of quality of life
Tullis, J. A., Roscoe, L. A., & Dillon, P. (2017) · Qualitative Research in Medicine & Healthcare · doi:10.4081/qrmh.2017.6152 · Cited by 7 · see citing works
Mugnai, G., Genovese, D., Tomasi, L., Gambaro, A., & Ribichini, F. L. (2025) · Trends in Cardiovascular Medicine · doi:10.1016/j.tcm.2025.09.005 · Cited by 4 · see citing works
Grubb, B. P., & Karabin, B. L. (2011) · Current Treatment Options in Cardiovascular Medicine · doi:10.1007/s11936-011-0136-7 · Cited by 4 · see citing works
Deactivation of cardiovascular implantable electronic devices in patients nearing end of life
Tischer, T. S., Bebersdorf, A., Albrecht, C., Manhart, J., Büttner, A., Öner, A. Ö., Şafak, E., İnce, H., Ortak, J., & Caglayan, E. (2019) · Herz · doi:10.1007/s00059-019-4836-1 · Cited by 3 · see citing works
Implanted Medical Devices and End-of-Life Decisions
Gill, M. B. (2015) · International library of ethics, law, and the new medicine/The international library of ethics, law, and the new medicine · doi:10.1007/978-3-319-22050-5_12 · Cited by 3 · see citing works
Norekvål, T. M., Kirchhof, P. F., & Fitzsimons, D. (2017) · European Journal of Cardiovascular Nursing · doi:10.1177/1474515117702558 · Cited by 3 · see citing works
Sterben mit/trotz Schrittmachers
Reith, S., & Janssens, U. (2014) · Medizinische Klinik - Intensivmedizin und Notfallmedizin · doi:10.1007/s00063-013-0282-7 · Cited by 3 · see citing works
Knochel, K., Barndt, I., Duttge, G., Dutzmann, J., Eggardt, T. J., Fuest, K. E., Meier, S., Michalsen, A., Nauck, F., Neukirchen, M., et al. (2025) · Medizinische Klinik - Intensivmedizin und Notfallmedizin · doi:10.1007/s00063-025-01330-4 · Cited by 2 · see citing works
Deactivation of Cardiac Implantable Electronic Devices (CIEDs) at the End of Life
Romanò, M. (2021) · Springer eBooks · doi:10.1007/978-3-030-80112-0_7 · Cited by 2 · see citing works
Kay, G. N., & Pelosi, F. (2013) · The Linacre Quarterly · doi:10.1179/2050854913y.0000000005 · Cited by 2 · see citing works
Self-citationSvanholm, J., Nielsen, J. C., Mortensen, P. T., Christensen, C. F., & Birkelund, R. (2015) · Nursing Ethics · doi:10.1177/0969733014564906 · Cited by 2 · see citing works
Kommentar I zum Fall „Einmal Schrittmacher – immer Schrittmacher?“
Indefrey, S., & Neitzke, G. (2016) · Ethik in der Medizin · doi:10.1007/s00481-016-0422-8 · Cited by 2 · see citing works
Lampert, R. J., & Hayes, D. L. (2011) · Elsevier eBooks · doi:10.1016/b978-1-4377-1616-0.00035-7 · Cited by 2 · see citing works
Knochel, K., Barndt, I., Duttge, G., Dutzmann, J., Eggardt, T. J., Fuest, K. E., Meier, S., Michalsen, A., Nauck, F., Neukirchen, M., et al. (2025) · Die Anaesthesiologie · doi:10.1007/s00101-025-01570-1 · Cited by 1 · see citing works
Discontinuation of Cardiac Devices at or Near an Adult Patient’s End of Life
McClung, J. A., Frishman, W. H., & Aronow, W. S. (2024) · Cardiology in Review · doi:10.1097/crd.0000000000000789 · Cited by 1 · see citing works
Management of Implanted Cardiac Rhythm Devices at End of Life
Lampert, R. J. (2014) · Springer eBooks · doi:10.1007/978-1-4471-6521-7_11 · Cited by 1 · see citing works
End of life decisions in heart failure
Ayach, B., Malik, A., Seifer, C. M., & Zieroth, S. R. (2017) · Current Opinion in Cardiology · doi:10.1097/hco.0000000000000366 · Cited by 1 · see citing works
Social and Ethical Principles of Device Therapy
Crawford, T., & Pelosi, F. (2016) · Elsevier eBooks · doi:10.1016/b978-0-323-37804-8.00044-4
Hayes, D. L., Tabatabaei, N., Glikson, M., Asirvatham, S. J., & Friedman, P. A. (2012) · Wiley eBooks · doi:10.1002/9781118483923.ch13
Sugrue, A. M., Vaidya, V. R., Hayes, D. L., Glikson, M., Friedman, P. A., & Asirvatham, S. J. (2021) · Wiley eBooks · doi:10.1002/9781119264002.ch13
Palliative pacemaker deactivation for a pacing-dependent patient
Petra, H., & Brady, J. (2026) · BMJ Supportive & Palliative Care · doi:10.1136/spcare-2025-006008
Wann ist es an der Zeit, die Devices abzuschalten?
Strohmer, B. (2014) · Journal für Kardiologie (Krause & Pachernegg GmbH)
- Authors
- Kay, G. N., & Bittner, G. T.
- Affiliations
- University of Alabama at Birmingham (US)
- ORCID
- Kay, G. Neal
- Venue
- Circulation: Arrhythmia and Electrophysiology
- Published
- 2009-06
- Volume
- 2
- Issue
- 3
- Pages
- 336-339
- ISSN
- 1941-3084 (ISSN-L)
- 1941-3149
- OpenAlex
- W2547613038
- Cited by
- 44
- References
- 11
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 2 · 2023: 1 · 2021: 2 · 2019: 1 · 2017: 4 · 2016: 2 · 2015: 7 · 2014: 3 · 2013: 3 · 2012: 7
- FWCI
- 5.02
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Circulation Arrhythmia and Electrophysiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
- Keywords
- terminal illness, end-of-life care, medical ethics, do-not-resuscitate orders, cardiac arrhythmias, cardiopulmonary resuscitation, treatment withdrawal
- MeSH terms
- Ethics, Medical, Humans, Pacemaker, Artificial, Terminal Care, Defibrillators, Implantable, Withholding Treatment
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
