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Death, Devices, and Double Effect

Stuart G Finder1, Michael Nurok2

  • 1Center for Healthcare Ethics, Cedars-Sinai Medical Center, 8700 Beverly Blvd, TSB 240, Los Angeles, CA, 90048, USA. stuart.finder@cshs.org.

HEC Forum : an Interdisciplinary Journal on Hospitals' Ethical and Legal Issues
|September 3, 2018
PubMed

Insights

The increasing use of total artificial hearts (TAHs) raises complex ethical questions regarding death determination and physician actions. These critical issues surrounding TAH technology require urgent ethical exploration and discussion.

Area of Science:

  • Medical Ethics
  • Cardiovascular Surgery
  • Biomedical Engineering

Background:

  • The total artificial heart (TAH) is increasingly utilized in treating end-stage heart failure.
  • The widespread adoption of TAH technology introduces novel ethical challenges previously unaddressed in medical literature.

Purpose of the Study:

  • To identify and highlight key ethical dilemmas associated with the use of total artificial hearts.
  • To underscore the necessity of exploring these ethical questions due to the growing prevalence of TAH technology.

Main Methods:

  • This study is a philosophical and ethical analysis.
  • It involves a critical review of existing ethical frameworks in the context of TAH technology.
  • The approach focuses on posing fundamental ethical questions rather than providing definitive answers.

Main Results:

  • The study identifies three primary ethical issues: (1) applying death determination criteria with a continuously functioning TAH, (2) the ethical justification for deactivating a TAH using the doctrine of double effect, and (3) the ethical basis for physician-initiated TAH deactivation when death is the direct outcome.
  • These issues stem from the TAH's artificial maintenance of circulatory function, challenging traditional concepts of death.

Conclusions:

  • The ethical implications of total artificial heart (TAH) utilization, particularly concerning death determination and physician-initiated deactivation, demand thorough ethical investigation.
  • Further scholarly and clinical discourse is essential to navigate these complex ethical landscapes as TAH technology advances.

Keywords:
Determination of deathDouble-effectEthicsTotal artificial heart

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