Deactivating implantable cardioverter-defibrillators (ICDs) in cancer patients: A scoping review of ethical considerations (pp. 99-105)
Authors: Adrianne Lebner Maxwell J. Smith
Abstract: Implantable cardioverter-defibrillators (ICDs) were developed in the 1980s to treat patients with life-threatening arrhythmias. These surgically implanted devices have since improved survival in patients, meaning that patients with ICDs are now surviving long enough to develop other fatal illnesses, like cancer. With patients surviving longer and developing terminal illnesses, it is important for health care practitioners to discuss the deactivation of ICDs as part of advance care planning discussions, as ICDs may not necessarily align with patientsí goals of care at the end of life. However, while important, this practice is not without ethical controversy. This scoping review therefore aims to explore the key ethical considerations and challenges that have been discussed in the literature regarding the deactivation of ICDs in terminally ill patients, and focuses specifically on patients with cancer. A search strategy of 3 electronic databases (Embase, Cochrane, and MEDLINE) was employed to identify relevant literature. Central themes identified in this literature that explores or examines ethical considerations for the deactivation of ICDs in cancer patients include: Conceptualizing ICDs as Medical Devices versus Biological Transplants; Autonomy, Informed Consent, and Advance Directives; Deactivating ICDs versus Euthanasia; and ICDs versus Pacemakers and Left Ventricular Assist Devices. There is broad agreement in the literature regarding the ethical permissibility of deactivating ICDs in patients with terminal illnesses such as cancer; however, this review indicates that ethical uncertainty and challenges will likely persist due to reported physician discomfort regarding the deactivation of ICDs and the absence of discussions regarding the deactivation of ICDs in advance care planning conversations.