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Is Left Ventricular Assist Device Deactivation Ethically Acceptable? A Study on the Euthanasia Debate.

Sara Roggi^1,2, Mario Picozzi³

¹Center 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.

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Summary

Patients with advanced heart failure may request withdrawal of their left ventricular assist device (LVAD). This study critiques the descriptive approach to ethical analysis and proposes a prescriptive approach based on proportionality for LVAD withdrawal requests.

Keywords:

Deactivation Device Euthanasia Left ventricular assist device Proportionality

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Area of Science:

Medical Ethics
Cardiology
Bioethics

Background:

Left ventricular assist devices (LVADs) improve survival for advanced heart failure (HF).
Patient vulnerability and requests for device withdrawal can arise during LVAD follow-up.
LVAD withdrawal hastens patient death, raising significant ethical concerns.

Purpose of the Study:

To analyze the ethical acceptability of left ventricular assist device (LVAD) withdrawal.
To critique the "descriptive approach" commonly used to define life-sustaining treatments for withdrawal decisions.
To propose a "prescriptive approach" grounded in proportionality for assessing patient requests for LVAD withdrawal.

Main Methods:

Ethical argument analysis of the "descriptive approach" in the context of LVADs.
Examination of criticisms against defining life-sustaining treatments to evaluate withdrawal.
Application of a "prescriptive approach" using the criterion of proportionality to patient requests.

Main Results:

The "descriptive approach" presents limitations when applied to LVAD withdrawal.
Critiques highlight the inadequacy of defining treatments solely to assess withdrawal acceptability.
A "prescriptive approach" offers a framework for ethically evaluating patient-initiated LVAD withdrawal.

Conclusions:

The ethical assessment of LVAD withdrawal requires moving beyond a simple definition of life-sustaining treatment.
A "prescriptive approach" based on proportionality provides a more nuanced ethical evaluation.
This framework supports ethically sound decision-making regarding patient requests for LVAD withdrawal.