End-of-life ethics
What ethics does a permanent heart pump raise?
Open access · cc by · source: Europe PMC
LVAD as destination therapy prolongs life in transplant-ineligible heart failure, but it also reshapes dying, consent, and caregiver burden.
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Whether a device can be switched off depends on law as much as on ethics.
Destination-therapy LVADs prolong life for transplant-ineligible heart failure patients but reshape dying, consent and caregiver burden; in Japan, where the law gives doctors no clear protection for withdrawing life support, the authors argue deactivation may be practically impossible and call for a patient-rights act, binding advance directives and immunity for proper withdrawal.
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What ethics does a permanent heart pump raise?
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REMATCH randomly assigned 129 transplant-ineligible patients: 68 to LVAD-DT and 61 to optimal medical management.
In a prospective, randomized, controlled trial (Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure [REMATCH]) conducted between May 1998 and July 2001, 129 patients with chronic end-stage heart failure who were ineligible for cardiac transplantation were randomly assigned to receive LVAD-DT (n = 68) or optimal medical management (OMM) (n = 61) []
What is destination therapy?
permanent destination therapy (DT) for patients with chronic end-stage heart failure who are not candidates for transplantation []. Using LVAD technology a
Key findings
LVAD-DT is intended to prolong survival and improve quality of life, yet complications and caregiver load can alter the dying trajectory. Consent must protect autonomy. Deactivation to allow death is discussed alongside the idea that withdrawing support can be morally equivalent to never starting it.
Methodology
The authors re-read survival and complication data from LVAD-DT trials (including REMATCH) and organise the ethical issues around informed consent, caregiver effects, and turning the device off near the end of life.
Limitations
This is not a new RCT. REMATCH numbers are cited from prior trials. It does not settle when a particular patient should refuse or deactivate a pump.
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