RT Journal Article
SR Electronic
T1 Left ventricular assist device withdrawal: an ethical discussion
JF BMJ Supportive & Palliative Care
JO BMJ Support Palliat Care
FD British Medical Journal Publishing Group
SP 193
OP 195
DO 10.1136/bmjspcare-2012-000347
VO 4
IS 2
A1 Sarah McLean
A1 Tara Ni Dhonnchu
A1 Niall Mahon
A1 Regina McQuillan
A1 Bert Gordijn
A1 Karen Ryan
YR 2014
UL http://spcare.bmj.com/content/4/2/193.abstract
AB Specialist palliative care (SPC) services are increasingly integrated with chronic heart failure (CHF) services. Left ventricular assist devices (LVADs) represent an advance in the management of advanced CHF, but may pose ethical challenges for SPC services providing care to this population. The patient received an LVAD as ‘bridge-to-heart-transplant,’ but subsequently experienced multiple cerebral haemorrhages, resulting in neurological deficits, and severe functional impairment. The risk of further cerebral events precluded ongoing anticoagulation, and she was transferred to an SPC inpatient unit for symptom control and end-of-life care. Following discussion within the multi-disciplinary team and with the patient's family, LVAD support was withdrawn, and the patient died peacefully. This piece reviews the ethical considerations that informed decision-making, in particular, autonomy, informed consent and futility. In addition, the question of the nature of LVADs is debated and how the perceptions of the patient, and others, of the device may influence decision-making around withdrawal of treatment.