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Sammanfattning

While implantable cardioverter-defibrillators (ICD) are life-saving devices for a steadily growing number of patients, they cannot prevent death of other causes than ventricular arrhythmias or bradycardia. Patients with an ICD who die of progressive heart failure or non-cardiac disorders like cancer do have the risk to get shock therapy near the end of life. Such therapies are not only medically inappropriate; they are distressing to patients, relatives and hospital personnel. We describe a case where a patient with a cardiac-resynchronization-therapy defibrillator (CRT-D) died in progressive heart failure and got several shocks from his CRT-D during the last day of his life. Some of the medical, ethical and practical aspects of deactivation of ICD-therapies will be discussed. Deactivation of ICD is often felt to be an act of assisted suicide or even euthanasia by many patients and physicians; however, the cause of death is the patient’s disease and not the deactivation of the device. The decision to deactivate an ICD must be part of a well-deliberated and documented process and can never be unilaterally decided upon by the physician. Hospitals that implant and control ICDs should have written routines about the process of device deactivation.

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