• BMJ Support Palliat Care · Jun 2014

    Left ventricular assist device withdrawal: an ethical discussion.

    • Sarah McLean, Tara Ni Dhonnchu, Niall Mahon, Regina McQuillan, Bert Gordijn, and Karen Ryan.
    • Palliative Care Service, St Francis Hospice, Dublin, Ireland.
    • BMJ Support Palliat Care. 2014 Jun 1; 4 (2): 193-195.

    AbstractSpecialist 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 Following discussion within the multi-disciplinary team and with the patient's family, LVAD support was withdrawn, and the patient died peacefully.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.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

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