Center to Advance Palliative Care

I know your query has been there a while but thought I would send a first-time comment as I have just entered the forum. Dr. Mike Rabow was our excellent mentor for the PCLC at UCSF and I agree with his source of Fast Fact and Concept #111 and #112 with the Web address he noted. We have been using these policies with our palliative inpatient consult service and our hospice service. When a patient is enrolled in hospice we discuss deactivation of the ICD but typically don't worry about the pacemaker as the shocks of the ICD are more likely to promote suffering while the pacer may maintain some continued quality of life by maintaining cardiac output, etc. I always review these decisions with the treating cardiologist and PCP. Our hospice service requires a DNR status and disabling the ICD only makes sense. It's my general experience that maintaining the pacemaker doesn't prolong life beyond the natural course expected.