When palliative becomes curative? An ethical dilemma in end-stage heart failure treated with compassionate stem cell...

Compassionate stem cell therapy (CST) is a potential treatment option for patients with end-stage heart failure who have exhausted all standard options. However, CST remains experimental. Its merits in treating heart failure are still being investigated with evidence so far suggesting limited or no sustained clinical benefit. We describe the case of a 65-year-old man receiving palliative care who underwent SCT, and whose end-of-life treatment decisions had to be reversed as a result of perceived clinical improvement. We consider the various ethical and medico-legal considerations that were weighed in the decision-making process. As access to non-standard therapies with uncertain efficacy increases, clinicians are likely to face similar challenging scenarios, but in the absence of clear guidelines. Hence, awareness of ethical and legal considerations, together with transparent, multi-disciplinary and shared decision-making, is vital to navigate these complex situations.