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Updated: Jun 11, 2026

Use of a Percutaneous Ventricular Assist Device/Left Atrium to Femoral Artery Bypass System for Cardiogenic Shock
Published on: August 16, 2021
Ethical analysis of withdrawing ventricular assist device support
Paul S Mueller1, Keith M Swetz, Monica R Freeman
1Division of General Internal Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA. mueller.pauls@mayo.edu
Patients with ventricular assist devices (VADs) can request withdrawal of support, which is ethically permissible. This withdrawal is considered a refusal of treatment, not euthanasia, for advanced heart failure patients.
Area of Science:
- Cardiology
- Bioethics
- Medical Law
Background:
- Ventricular assist devices (VADs) are life-sustaining treatments for advanced heart failure.
- Patient autonomy and the right to refuse treatment are fundamental ethical principles.
Observation:
- A retrospective review identified 14 patients who requested VAD withdrawal.
- Requests were primarily made by surrogates (12/14), with no advance directives mentioning VADs.
- Multidisciplinary conferences preceded withdrawal in most cases; ethics consultations were rare.
Findings:
- All 14 patients died within one day of VAD withdrawal.
- The study supports the ethical permissibility of VAD withdrawal requests.
- Withdrawal of VAD support is viewed as a refusal of treatment, not physician-assisted suicide or euthanasia.
Implications:
- Healthcare providers should respect patient autonomy regarding VAD support.
- Legal and ethical frameworks should accommodate VAD withdrawal requests.
- This supports patient-centered care in advanced heart failure management.
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