As Implantable Cardioverter Defibrillators (ICDs) have become more common, ethical issues have arisen regarding the deactivation
of these devices. Goldstein et al., have shown that both patients and cardiologists consider ICD deactivation to be different
from the discontinuation of other life-sustaining treatments. It cannot be argued ethically that ICDs raise new questions
about the distinction between withholding and withdrawing treatment, and neither the fact that they are used intermittently,
nor the duration of therapy, nor the mere fact that they are located inside the body can be considered unique to these devices
and morally decisive. However, frequent allusions to the fact that they are located inside the body might provide a clue about
what bothers patients and physicians. As technology progresses, some interventions seem to become a part of the patient as
a unified whole person, completely replacing body parts and lost physiological functions rather than merely substituting for
impaired structure and function. If a life-sustaining intervention can be considered a “replacement”—a part of the patient
as a unified whole person—then it seems that deactivation is better classified as a case of killing rather than a case of
forgoing a life-sustaining treatment. ICDs are not a “replacement” therapy in this sense. The deactivation of an ICD is best
classified, under the proper conditions, as the forgoing of an extraordinary means of care. As technology becomes more sophisticated,
however, and new interventions come to be best classified as “replacements” (a heart transplant would be a good example),
“discontinuing” these interventions should be much more morally troubling for those clinicians who oppose euthanasia and assisted
suicide.
KEY WORDS implantable cardioverter defibrillators - ethics - withholding treatment