Finding this out came as a surprise for many, and they reported that thoughts about dying were not discussed between them, their spouses and their healthcare professionals. Others reported that they only thought a device would be deactivated in cases where it needed to be changed; the battery had run out, if they had an infection or an MRI was required. Some reported that their clinician may have told them in passing about end of life care and deactivation issues, although they didn t feel that this was fully discussed. Explanation of quality assessment: moderate methodological limitations in the studies contributing to this sub-finding; minor concerns about the coherence of the finding; partial relevance due to the contributing studies being conducted outside of the UK; minor concerns about inadequacy as the evidence provided reasonable depth. There was an overall judgement of low confidence in this sub- finding due to the concerns regarding the methodological limitations and relevance. Chronic Heart Failure Advanced heart failure and palliative care NICE 2018. All rights reserved. Subject to Notice of rights. ISBN: 978-1-4731-3093-7 Review sub-finding 2: Misconception Some people perceived ICD deactivation to be equivalent to euthanasia or assisted suicide, with some believing that it would lead to immediate death. In these cases they reported only wanting to consider deactivation when they were brain dead . They felt that a cardiac arrest was a threat to their lives, and healthcare professionals were obligated to treat them. Some patients also said that they would never want their ICD to be deactivated because this was the equivalent to suicide and therefore against their faith. 