رجل عمره ٨٠ سنة في مرحلة متقدمة من فشل القلب، يدخل المستشفى كل شهر، وقرر مع عائلته التحول للرعاية التلطيفية والبقاء في البيت. عنده جهاز صدمات مزروع منذ ٥ سنوات. ما الموضوع الذي يجب أن يُناقش؟

An 80-year-old man with advanced heart failure is admitted monthly and, with his family, has decided on palliative care at home. He has had an ICD for 5 years. Which topic must be discussed?

1. Urgent surgical removal of the device
2. Deactivating the shock function of the device
3. Stopping all comfort drugs such as morphine
4. Making the device more sensitive to shock

Answer: B) Deactivating the shock function of the device. At the end of life an ICD can deliver painful, repeated and futile shocks. Shock therapy can be turned off by non-invasive reprogramming after discussion with the client, family and team, as part of good palliative care.