title: Ethical dilemmas surrounding the use of ventricular assist devices in supporting patients with end-stage organ dysfunction.
abstract: Successful practice of cardiovascular medicine requires familiarity with the complex ethical issues that accompany therapeutic innovation and diffusion. Even as technologies transition from experimental to standard care, challenges remain. Mechanical circulatory support devices, for instance, are increasingly conceptualized as conventional therapies. Despite this, or perhaps because of it, the ethical issues surrounding the use of these devices in patients with end-stage organ dysfunction are becoming increasingly apparent. In this paper, we provide an introduction to ethical considerations related to the use of ventricular assist devices (VADs) in end-stage organ failure, focusing on three stages or decision points: initiation, continued use, and deactivation. Our goal is not to exhaustively resolve these dilemmas but to illustrate how ethical considerations relate to decision making.
authors.affiliation: The Methodist Hospital, Houston, Texas, USA.
authors.forename: Courtenay R
authors.initials: CR
authors.lastname: Bruce
authors.forename: Baruch
authors.initials: B
authors.lastname: Brody
authors.forename: Mary A
authors.initials: MA
authors.lastname: Majumder
mesh_terms: D001291:Attitude of Health Personnel; D003661:Decision Support Techniques; D007722:Health Knowledge, Attitudes, Practice; D006333:Heart Failure / Q000503:physiopathology / Q000628:therapy*; D006353:Heart-Assist Devices / Q000009:adverse effects / Q000941:ethics*; D006801:Humans; D028681:Moral Obligations; D010358:Patient Participation; D018579:Patient Selection / Q000941:ethics*; D010820:Physicians / Q000941:ethics* / Q000523:psychology; D011788:Quality of Life; D020127:Recovery of Function; D016896:Treatment Outcome; D016312:Treatment Refusal / Q000941:ethics*; D016276:Ventricular Function
keywords: bioethics; ethics; left ventricular assist devices; mechanical circulatory support