Dear Rabbi Halperin
Noam Zohar suggested that I contact you. I am on the ethics committee at the U of Illinois at Chicago medical center, and a member of our committee is going to be giving a presentation on the deactivation of pacemakers and implantable defibrillators in terminally ill patients. I am a frequent speaker on Jewish law and end-of-life decision-making, so she asked me what the Orthodox viewpoint is on this topic, and I'm afraid I have been unable to locate any definitive answers. Would you be able to provide an answer or direct me to references?
Thank you so much.
There is a fundamental difference between a pacemaker and an implanted defibrillator. Deactivating a pacemaker is considered by most poskim as murder. Regarding the defibrillator there is a debate amongst the poskim. According to Rabbi Elyashiv, since the defibrillator has become de-fact a part of the patient's body, deactivating the implantable defibrillator is equivalent to neutralizing another crucial defense mechanism of the body and therefore is prohibited.
In contrast, according to Rabbi Shlomo Zalman Eurbach Ztz"l the defibrillator is not considered a part of the patient's body. Therefore in those cases where resuscitation is no longer compulsory, it is also permissible to deactivate the defibrillator.
See Prof. Abraham Steinberg : "Halakhic Guidelines for Physicians in Intensive Care Units" that defines the possible refraining of resuscitation in cases of terminal ICU patients.