Abstract
Cardiac pacemaker therapies, such as implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization therapy (CRT) devices, have transformed the management of cardiac arrhythmias and heart failure, improving patient outcomes. However, these therapies raise significant ethical challenges, including conflicts of interest in device selection, dilemmas in pacing mode choices, and decisions surrounding device deactivation at end-of-life. This article focuses on the interplay between ethical principles, patient autonomy, and resource allocation in these contexts, proposing practical solutions and exploring cultural and legal perspectives. Addressing these challenges is essential to ensure patient-centered, ethically sound cardiac care.