American Academy of Hospice and Palliative Medicine

View all recommendations from this society

Released February 21, 2013; Revised January 14, 2021

Don’t leave an implantable cardioverter-defibrillator (ICD) activated when it is inconsistent with the patient/family goals of care.

In many patients with ICDs, the defibrillator fires during the days preceding death. For patients with advanced irreversible diseases, defibrillator shocks rarely prevent death and may be a source of pain for patients and distress for caregivers and family members. Advance care planning discussions should include the option of deactivating the ICD when it no longer supports the patient’s goals.

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

The American Academy of Hospice and Palliative Medicine’s (AAHPM) president appointed a special task force to coordinate the development of the Academy’s recommendations. Chaired by a member of the Board of Directors who had previously overseen AAHPM’s education and training committees, the task force included representatives of the Academy’s Quality and Practice Standards Task Force, Research Committee, Ethics Committee, Public Policy Committee and External Awareness Task Force, as well as at-large appointees that represent distinguished leaders in the field. The task force solicited input from AAHPM’s 17 Special Interest Groups, and task force members also offered their own suggestions for the list. Considering the potential impact and evidence to support the proposed recommendations, the task force identified seven finalists for which a rationale and evidence base was further developed. All AAHPM members were invited to comment on and rank these seven recommendations. Member feedback informed the task force’s final deliberation, which included narrowing the list to the “Five Things” and refining the verbiage of the recommendations. The list was then reviewed and approved by the AAHPM Executive Committee.

AAHPM’s disclosure and conflict of interest policy can be found at


Berger JT. The ethics of deactivating implanted cardioverter defibrillators. Ann Intern Med. 2005;142:631-634.

Goldstein N, Carlson M, Livote E, Kutner J. Brief communication: Management of implantable cardioverter-defibrillators in hospice: A nationwide survey. Ann Intern Med. 2010;152(5):296-299.

Goldstein NE, Lampert R, Bradely EH, Lynn J, Krumholz HM. Management of implantable cardioverter defibrillators in end-of-life care. Ann Intern Med. 2004;141(11):835-838.

Russo, J. Deactivation of ICDs at the end of life: A systematic review of clinical practices and provider and patient attitudes. Am J Nurs. 2011;111(10):26-35.