• Sara Roggi and Mario Picozzi.
• Center for Clinical Ethics (CREC), Doctoral School in Clinical and Experimental Medicine and Medical Humanities, Biotechnologies and Life Sciences Department, Insubria University, Via Ottorino Rossi 9, 21100, Varese, Italy. sararoggi92@gmail.com.
• HEC Forum. 2021 Dec 1; 33 (4): 325-343.

AbstractIn the last decades, new technologies have improved the survival of patients affected by chronic illnesses. Among them, left ventricular assist device (LVAD) has represented a viable solution for patients with advanced heart failure (HF). Even though the LVAD prolongs life expectancy, patients' vulnerability generally increases during follow up and patients' request for the device withdrawal might occur. Such a request raises some ethical concerns in that it directly hastens the patient's death. Hence, in order to assess the ethical acceptability of LVAD withdrawal, we analyse and examine an ethical argument, widely adopted in the literature, that we call the "descriptive approach", which consists in giving a definition of life-sustaining treatment to evaluate the ethical acceptability of treatment withdrawal. Focusing attention on LVAD, we show criticisms of this perspective. Finally, we assess every patient's request of LVAD withdrawal through a prescriptive approach, which finds its roots in the criterion of proportionality.© 2020. The Author(s).

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