LAW, ETHICS AND MEDICINE

The ethical and legal implications of deactivating an implantable cardioverter-defibrillator in a patient with terminal cancer

Ruth England¹, Tim England² and John Coggon³

¹ John Eastwood Hospice, Sutton-in-Ashfield, Nottinghamshire, UK
² Health Care of the Elderly, Queens Medical Centre, Nottingham, UK
³ Postgraduate Research Office, Cardiff Law School, Cardiff University, Cardiff, UK

Correspondence to:
Correspondence to:
MrJ Coggon
Postgraduate Research Office, Cardiff Law School, Cardiff University, Museum Avenue, Cardiff CF10 3XJ, UK; coggonj{at}cf.ac.uk

In this paper, the ethical and legal issues raised by the deactivation of implantable cardioverter-defibrillators (ICDs) in patients with terminal cancer is considered. It is argued that the ICD cannot be well described either as a treatment or as a non-treatment option, and thus raises complex questions regarding how rules governing deactivation should be framed. A new category called "integral devices" is proposed. Integral devices require their own special rules, reflecting their position as a "halfway house" between a form of treatment and a part of the body. The practical problems faced by doctors working in palliative medicine with regard to the deactivation of ICDs are also considered.

Abbreviations: ICD, implantable cardioverter-defibrillator

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