Ethical Challenges in Care of Patients on Mechanical Circulatory Support at End-of-Life
- PDF / 349,904 Bytes
- 8 Pages / 595.276 x 790.866 pts Page_size
- 5 Downloads / 190 Views
ETHICS/PALLIATIVE CARE (S FEDSON, SECTION EDITOR)
Ethical Challenges in Care of Patients on Mechanical Circulatory Support at End-of-Life Esther S. Pak 1 & Christopher A. Jones 2 & Paul J. Mather 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review Although the utilization of mechanical circulatory support (MCS) devices is increasing, ethical dilemmas regarding device deactivation and dying process persist, potentially complicating delivery of optimal and compassionate care at end-of-life (EOL). This review aims to study EOL challenges, left ventricular assist devices (LVADs) as a nuanced life support treatment, legal history in the US impacting EOL care, and suggestions to improve EOL care for patients on MCS support. Recent Findings Recent studies have demonstrated challenging aspects of EOL care for patients on LVAD support: low use of advanced directives, high rates of surrogate decision-making due to lack of patient capacity, difficult decision-making involving LVAD deactivation even with cooperating patients, and high rates of death in the hospital and ICU settings. Recent studies also suggest lack of consensus even among clinicians in approaching LVAD deactivation as beliefs equating LVAD deactivation with physician-assisted suicide and/or euthanasia remain. Optimal care at EOL will likely require collaborative efforts among multiple specialties, caregivers, and patients. Summary In light of the complex medical, logistical, and ethical challenges in EOL care for LVAD patients, there is room for improvement by multidisciplinary efforts to reach consensus about LVAD deactivation and best practices for EOL care, development and implementation of LVAD-specific advance planning, and protocols for LVAD deactivation. Programmatic involvement of hospice and palliative care in the continuum of care of LVAD patients has the potential to increase and improve advance care planning, support surrogate decision-making, improve EOL compassionate care, and to support caregivers. Keywords End-of-life care . Life support treatment . Mechanical circulatory support . Palliative care . Hospice
Introduction Since the first FDA approval in 1984 for MCS for bridge to transplantation, surgical implantation of mechanical circulatory support (MCS) such as left ventricular assist devices (LVAD), biventricular assist devices, and total artificial heart (TAH) is increasingly performed in patients with end-stage heart failure with the intentions of increasing survival, improving quality of This article is part of the Topical Collection on Ethics/Palliative Care * Esther S. Pak [email protected] * Paul J. Mather [email protected] 1
Division of Cardiovascular Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
2
University of Pennsylvania, Hospice & Palliative Care Medicine, Philadelphia, PA 19104, USA
life, and increasing functional capacity [1, 2]. However, MCSrelated complications can negatively impact quality of life for both patients and
Data Loading...
