There was an overall judgement of very low confidence in this sub-finding due to the concerns regarding the methodological limitations, relevance and adequacy. Review sub-finding 4: Wanting to deactivate Some ICD recipients felt that they would only deactivate their device when their quality of life was so low that they were bedridden or unable to engage in daily activities. They felt that if they had no hope of a meaningful recovery and were at a terminal point of their illness, then they would want to deactivate their device. They also felt that if they were in a lot of pain and had had numerous shocks than they might want to deactivate their device. Other elderly patients had been seeking information about whether they could refuse an ICD replacement, feeling that they might be ready to die soon; although they had not discussed these thoughts with loved ones or healthcare professionals. Family members felt that they would only agree to deactivate the ICD if all hope was gone and their partner no longer had a 'worthy' life. Many expressed that they would not want their partner to suffer and be in pain in their last days of life, which an active ICD could cause. In these cases, they felt there was no reason to prolong the inevitable and cause extra suffering by keeping an ICD going. Similarly, some doctors agreed and in these situations did not feel like they were killing the patient. Nurses also supported deactivation when the patient had been well informed. They reported that this often would happen when patients were undergoing withdrawal of other life-sustaining treatments, and was done to improve patient comfort and avoid ongoing shocks. Chronic Heart Failure Advanced heart failure and palliative care NICE 2018. All rights reserved. Subject to Notice of rights. 