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J Med Ethics 2007;33:538-540 doi:10.1136/jme.2006.017657
  • Law, ethics and medicine

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

  1. Ruth England1,
  2. Tim England2,
  3. John Coggon3
  1. 1John Eastwood Hospice, Sutton-in-Ashfield, Nottinghamshire, UK
  2. 2Health Care of the Elderly, Queens Medical Centre, Nottingham, UK
  3. 3Postgraduate Research Office, Cardiff Law School, Cardiff University, Cardiff, UK
  1. Correspondence to:
 MrJ Coggon
 Postgraduate Research Office, Cardiff Law School, Cardiff University, Museum Avenue, Cardiff CF10 3XJ, UK; coggonj{at}cf.ac.uk
  • Received 1 June 2006
  • Accepted 1 September 2006
  • Revised 20 July 2006

Abstract

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.

Footnotes

  • Competing interests: None.

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