Turning off your ICD

Summary of an Article by Cigna Insurance and information​ from the American Heart Association

What is an ICD?

An ICD (implantable cardioverter-defibrillator) regulates your heart beat.  It is always checking your heart rate and rhythm. If the ICD detects a life-threatening rapid heart rhythm, it tries to slow the rhythm to get it back to normal. If the dangerous rhythm doesn’t stop, the ICD sends an electrical shock to the heart to restore a normal rhythm.

Your ICD may also work as a pacemaker. It can fix a heart rate that is too fast or too slow. It may do so without using a shock.

How does your ICD help you?

Your ICD can save your life.  It regulates your heart, and was implanted because your heartbeat may have been irregular, or for other reasons.  Even though an ICD can help fix heart rate or rhythm problems, you may not want this at the end of life.

Should you consider turning off your ICD?

Many people consider turning off their ICD when their health goal changes from living longer to getting the most comfort possible at the end of life. The shocks the ICD delivers are painful. Not being shocked will make you more comfortable at the end of life.

What happens if the ICD is turned off?

Turning off an ICD is easy and it isn’t painful.  Your doctor will use a computer to reprogram the ICD so that it doesn’t give you shocks.
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 your ICD is combined with a pacemaker, you can elect to turn off the ICD or the pacemaker, or both.  Turning off a pacemaker means your heart might not pump blood as well as it should. This could make you feel worse instead of more comfortable.  Depending on your heart condition, turning off a pacemaker could result in death.

Who makes the decision?

You make the decision about whether or not you want to turn off your ICD.  This is not an easy decision to make, so you should involve your family, your doctor, your spiritual adviser, and your friends.

How can I direct my  loved ones to turn off the ICD?

The decision to turn off your ICD is part of the medical treatment you want at the end of life. You can put this information in your advance directive**To be sure, Make sure your advance directive permits the tuning off or removal of a pacemaker​ or ICD.  Call us if you’d like to add this to your advance directive.

Turning off your ICD is legal, and 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.It’s your decision. You can change your mind at any time.

** Advance directives, also referred to as living wills, can address a number of issues, such as whether a patient wants to receive artificial respiration, dialysis, tube feeding or artificial hydration, or donate an organ in the event of death. The document may also include a do-not-resuscitate-order, which instructs doctors not to perform C​PR if the patient stops breathing or their heart stops.

“An advance directive provides a clear statement by the patient of his or her wishes with respect to his or her health care,” said William Roach Jr., Esq., an American Heart Association volunteer and co-author of Medical Records and the Law, now in its fourth edition. “This helps to avoid disputes that can arise among family members concerning how to treat an incapacitated relative and gives direction to healthcare providers concerning the level of care to provide the patient.”

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