1) Implantable defibrillators are increasingly common but can pose ethical dilemmas at end of life if they prolong suffering through repeated shocks in terminally ill patients.
2) Studies have found withdrawing defibrillator therapy is acceptable if it is consistent with patient values and palliative care is provided, and that time to death is often not affected by withdrawing pacemaker support.
3) Guidelines recommend discussions with patients and surrogate decision makers and palliative care planning before disabling devices to avoid unwanted prolongation of death or suffering from shocks.
![Case ,[object Object],[object Object],Braun TC, Hagen NA, Hatfield RE, Wyse DG. Cardiac pacemakers and implantable defibrillators in terminal care. J Pain Symptom Manage. Aug 1999;18(2):126-131.](data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7)