IMPLANTABLE CARDIOVERTER - DEFIBRILLATOR DEACTIVATION IN PATIENTS NEARING THE END OF LIFE

All healthcare professionals who treat patients with implantable cardioverter-defibrillator (ICD) and terminal diseases must to do everything in order to make the death less suffering. Terminally ill patients are more likely to develop conditions predisposing them to repetitive ventricular arrhythmias which are hard to control thus increasing the frequency of shock therapy. Implantable cardioverter-defibrillators deactivation in patients with irreversible or terminal illness must be based on ethical and legal principles, as well as on clinical, scientific and technical experience. The ultimate judgment regarding this procedure must be made by the patient (or in special conditions by the legal representative) after careful communication about the consequences of deactivation, having the legal and ethical right to refuse it. The physician asked to deactivate the ICD and the representative of the ICD produce, when asked to assist can conscientiously object to and refuse to perform device deactivation. In this paper, the issue of when it is appropriate to deactivate these devices if the patient becomes terminally ill and the ethically and medicolegal consequences of this action are examined. Not every European country (including Romania) has a national legislation covering this problem despite of increasing numbers of ICDs. That's why ICD deactivating is sometimes avoided. This paper could help all healthcare professionals in this situation and could contribute to a higher clinical management of medical care for terminal patients.