title: Ethical dilemmas in device treatment for advanced heart failure.
abstract: OBJECTIVE
  This review discusses the ethical issues raised by the increased use of devices to treat heart failure.
  
  
  RESULTS
  Recent guidelines and clinical trials describe the benefits of device therapy in advanced heart failure. Other studies and commentaries illustrate the potential for harm, both to the individual patient in the form of reduced quality of life and to society in the form of unbearable costs. Recent reports discuss the specific issues involved with deactivating different devices and document low rates of advanced care planning in relation to device management at the end of life.
  
  
  CONCLUSIONS
  More research, increased end-of-life education, renewed emphasis on advance directives, and a true multidisciplinary approach are needed to provide optimal care for heart failure patients in relation to device therapy.
authors.affiliation: Department of Medicine, Cardiovascular Division and Bioethics Center, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
authors.forename: James N
authors.initials: JN
authors.lastname: Kirkpatrick
authors.forename: Savitri E
authors.initials: SE
authors.lastname: Fedson
authors.forename: Ralph
authors.initials: R
authors.lastname: Verdino
mesh_terms: D016223:Advance Directives; D017147:Defibrillators, Implantable / Q000941:ethics*; D026690:Ethics, Clinical; D006333:Heart Failure / Q000628:therapy*; D006353:Heart-Assist Devices / Q000941:ethics*; D006801:Humans; D010138:Pacemaker, Artificial / Q000941:ethics*; D040841:Resource Allocation / Q000941:ethics