High-tech medical devices can raise tricky ethical questions — just consider the left ventricular assist device (LVAD). The pricey device essentially takes over the function of the left ventricle, helping a heart to continue beating when it would otherwise fail. But what happens when patients become very, very sick and are essentially being kept alive by the LVAD? Is turning off the device more akin to euthanasia or taking someone off a ventilator?
In a study published online in Mayo Clinic Proceedings, Mayo researchers come down firmly on the side of the latter, describing 14 cases where patients or their health-care surrogates requested the assist device be turned off.
The researchers write that in the U.S. “it is ethically and legally permissible” for physicians to comply with requests by patients (or their representatives) to “refuse or to request withdrawal of life-sustaining treatments” such as hemodialysis or artificial nutrition. But LVADs make some clinicians uncomfortable for several reasons, they write — the device seems almost like a replacement part than outside assistance, for example.
Researchers write, though, that withdrawing LVAD support isn’t the same as assisted suicide or euthanasia because there’s no “new pathology” introduced to cause death. Death, when it comes (all 14 patients died within a day of turning off the device), is due to the underlying heart failure, they write. So assuming patients or their representative know the consequences of deactivating the device, clinicians should honor their wishes.
Since January 2009, patients at Mayo who are weighing an LVAD as a life-long solution, not just a way to stay alive while waiting for a heart transplant, specifically discuss what they want to happen to their device under certain circumstances. Generally, the policy “has been well received by patients, their loved ones, and the health-care team,” the authors write.
LVAD Bonus: Read WSJ reporter Ron Winslow’s 2005 story of one man and his life-saving LVAD.
Photo by CarbonNYC via Flickr