Current evidence suggests that many patients are unaware of the possibility that their ICD can be deactivated without surgery.S14-1 S14-3 During deci- sion-making, clinicians do not routinely inform patients about ICD deactivation.S14-4 Clinicians even disagree on whether discussions of deac- tivation should occur when patients are making a decision about an ICD-related procedure.S14-5 As a result, patients often do not include wishes about deactivation in advance care planning Consequently, surrogates usually make decisions about ICD deactivation without any prior discussions with the patient.S14-6 In hypo- thetical scenarios, patients with ICDs were able to identify scenarios in which they might choose to deactivate their ICD.S14-1,S14-7 This discussion can occur at any time, but it is particularly important to have it at the time of initial ICD implantation, at the time of reimplantation, and during prepa- ration of advance care plans. 2. When ICDs are not deactivated at the end of life, patients and families suffer unnecessarily. Families have had unpleasant experiences of watching their loved one die while getting shocked repeat- edly by an ICD.S14-8 In 1 survey of hospice staff, half of those surveyed noted that a deceased patient had been shocked by an ICD during the year prior to the survey.S14-9 This is unnecessary and easily preventable by having caring, patient-centered discussions with patients and their loved ones. In general, patients want their clinicians to initiate so this recommenda- tion is carefully worded to put the responsibility of initiating the discussion on the clinician. Ethically, patients and surrogates are free to choose to deactivate antitachycardia function.S14-11 S14-13 Most patients only elect deactivation of the anti- tachycardia functions while leaving the pacing function on. 