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Ethical and Legal Concerns Associated With Withdrawing Mechanical Circulatory Support: A U.S. Perspective
1Department of Medicine, Division of General Internal Medicine, Mayo Clinic Health System, La Crosse, WI, United States.
Frontiers in Cardiovascular Medicine
|August 12, 2022
Summary
Withdrawing mechanical circulatory support (MCS) for advanced heart failure is ethically and legally permissible in the U.S. when requested by patients or surrogates due to burden, not to end life.
Area of Science:
- Cardiology and Bioethics
- Focuses on ethical and legal considerations of mechanical circulatory support (MCS) in advanced heart failure management.
Background:
- Advanced heart failure affects hundreds of thousands, with symptoms persisting despite optimal treatment.
- Heart transplantation is limited by organ availability, making mechanical circulatory support (MCS) a crucial alternative.
- MCS offers symptom relief, prolonged survival, and serves as a bridge to transplant or destination therapy.
Purpose of the Study:
- To review ethical and legal concerns surrounding requests to withdraw mechanical circulatory support (MCS).
- To clarify the permissibility of withdrawing life-sustaining treatment (LST) based on patient values or medical ineffectiveness.
Main Methods:
- Review of ethical and legal frameworks in the U.S. regarding withdrawal of life-sustaining treatment (LST).
- Discussion of scenarios involving patient/surrogate requests for MCS withdrawal and clinician recommendations for withdrawal due to medical ineffectiveness.
- Exploration of patient characteristics, advance care planning, and related ethical/legal topics concerning MCS withdrawal.
Main Results:
- Withdrawal of LST, including MCS, is ethically and legally permissible in the U.S. if the intent is to alleviate patient burden, not to cause death.
- Death following LST withdrawal is attributed to the underlying disease, not physician-assisted suicide or euthanasia.
- The article addresses clinician perspectives on medically ineffective LST and patient profiles undergoing MCS withdrawal.
Conclusions:
- Informed patient or surrogate requests to withdraw burdensome MCS are ethically and legally supported in the U.S.
- Advance care planning is essential for patients considering or receiving MCS to align treatment with personal values.
- Understanding the ethical and legal landscape is crucial for managing complex decisions regarding MCS withdrawal.
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