Overview

An ICD is always checking your heart for a life-threatening, rapid heart rhythm. The ICD may try to slow the rhythm back to normal using electrical pulses. If the dangerous rhythm doesn't stop, the ICD sends an electric shock to the heart. This restores a normal rhythm. The device then goes back to its watchful mode.

Your doctor will program the ICD to send electrical pulses or a shock when needed.

Why turn off your ICD?

You may want to consider turning off your ICD if your health goal changes from living longer to getting the most comfort possible at the end of life.

Even though an ICD can help fix heart rate or rhythm problems, you may not want this at the end of life. The shocks the ICD delivers are painful. Not being shocked may make you more comfortable.

As you plan for your future and your end of life, include plans for your ICD. Your decision about your ICD can be included in your treatment plan. And you can put this information in your advance directive.

Turning off your ICD is legal. It isn't considered suicide. The decision to leave on or turn off your ICD is a medical decision you make based on your values.

How do you turn off an ICD?

Your ICD can be turned off by your doctor. They will use a computer to reprogram it so that it doesn't give you shocks.

This procedure isn't hard or painful. The ICD isn't taken out of your chest, and you don't need surgery. Turning off the ICD won't cause death, and it won't make you feel worse. But because the ICD won't give you a shock if you have a life-threatening heart rhythm, this type of heart rhythm could lead to death.

If you change your mind, the ICD can be turned back on.

Some ICDs are combined with a pacemaker. You can turn off the ICD without turning off the pacemaker. Your doctor can explain how your pacemaker might affect you at the end of your life.

How do you decide?

Many things can help you decide to leave on or turn off your ICD. It can be a tough decision. But it is yours to make. You don't have to do it alone. Look to your family, your doctor, your spiritual advisor, and your friends for help and support.

Things to think about:

• Your future and quality of life. What can you expect as your health problems get worse? What type of health care do you want at the end of life? Do you want to be shocked by your ICD if it may not help you live much longer?
• Your health. Is a heart problem your only health problem?
• Timing. When do you want to turn off the ICD? Some people wait until the end of life is close. Others want it turned off well before this.
• Personal issues. Do you have any personal goals you would like to meet? Do you need to say any final goodbyes? You may want to keep your ICD on until you can achieve them.
• Your care and comfort. If you turn off your ICD, you will still receive your usual care. You'll still be treated for other health problems and have doctor visits as necessary. If it is toward the end of life, you can still get care, called hospice care, that focuses on pain relief, comfort, and the quality of your life.
• An advance directive. Do you want to put your instructions in an advance directive? Do you want this decision to be made earlier or later? Do you want to be sure your wishes are followed?
• It's your decision. You can change your mind at any time.