Abstract
In 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.
Highlights
Over the last century, technological advancement has given birth to ethical concerns over the role of téchne in clinical practice and the emergence of ethical implications of its utilization in end-of-life issues
According to the National Health and Nutrition Examination Survey (NAHNES), the 2018 report of the American Heart Association (Benjamin et al 2018) observed that 6.5 million adult Americans suffered from heart failure (HF) from 2011 to 2014; this result represented a significant increase as the same statistics, for the 2009 to 2012 period, showed that less than 6 million people—just under 5.9 million US adults—suffered from HF
As the number of patients with HF continues to rise in contrast to that of donors available for heart transplant, and as the time spent on waiting list is unpredictable, clinical development in mechanical circulatory support (MCS) devices represents an important contribution for patients’ survival (Stewart and Givertz 2012; Burkhoff et al 2015)
Summary
Technological advancement has given birth to ethical concerns over the role of téchne in clinical practice and the emergence of ethical implications of its utilization in end-of-life issues. The most predominant in contemporary clinical practice (Milani and Lavie 2015), are more challenging than acute diseases because they require ongoing therapy until the very end of life. In such clinical cases, patients live in a permanent pathological state of deficiency that they must learn to live with. As the Eighth Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) annual report shows, the development in technological circulatory support has constituted an innovative alternative for patients suffering from heart failure, reducing adverse effects, improving life expectancy and patients’ overall quality of life (Kirklin et al 2017; Mancini and Colombo 2015)
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