This patient's request for implantable cardioverter-defibrillator (ICD) deactivation should be carried out. Patients have the right to refuse or request the withdrawal of any treatment, even those that are life prolonging (that is, death inevitably follows withdrawal of the treatment). In these circumstances, the physician's duty is to understand the reasons for the request and to ensure that the request is informed. Patients who have ICDs may experience uncomfortable shocks during the dying process, and in order to avoid shocks, some patients request ICD deactivation. This patient understands the consequences of ICD deactivation, and her request should be fulfilled. In caring for a patient at the end of life, withdrawing a treatment that is perceived by the patient as burdensome or may cause discomfort (in this case, ICD shocks) is consistent with comfort care.

No treatment has unique moral status; that is, there is no treatment that must always be administered or must be continued once started. Because this patient has demonstrated clear and consistent decision-making capacity, it is unethical to refuse to comply with her wishes and continue the ICD.

It is ethically and legally permissible for physicians to withhold or withdraw treatments from patients who no longer want them without need for a psychiatric evaluation, provided the patient demonstrates clear and consistent decision-making capacity. In addition, a psychiatric evaluation cannot determine a patient's competence, as that is a legal determination made in a court of law.

It is illegal to invoke this patient's power of attorney and advance directive, as these only go into effect at a time when the patient herself is unable to make her own decisions. As long as the patient is awake and demonstrates decision-making capacity, her decisions override those of her power of attorney and those outlined in her advanced directive.