When implantable cardioverter-defibrillators (ICDs) were first in broad use, about 20 years ago,1 they often seemed like a near-magical way to kick a troublesome heart back into doing its job. Without the serious risks and low yield of external cardiopulmonary resuscitation, a person could be resuscitated without even having lost consciousness. When I gave a talk to the Heart Failure Society of America a dozen years ago, only 1 team in the assembly regularly told patients as part of their initial consent process that they might someday want to turn off their device, and that team was from Canada. Already, those of us serving hospices had our horror stories circulating—of patients whose last days were marked by multiple shocks, of difficulties getting the devices turned off, and of patients whose last hours were spent anguishing over whether turning the ICD off would be suicide.
Lynn J. A Maturing Use of Defibrillators. JAMA Intern Med. 2016;176(7):886. doi:10.1001/jamainternmed.2016.1933