title: A review of ethical considerations for ventricular assist device placement in older adults.
abstract: This article reviews some of the complex ethical issues that accompany the diffusion of ventricular assist devices (VADs) for heart failure patients, with a particular emphasis on issues unique to older adults. In doing so, the ethical issues are centered on three decision points: (a) patient selection; (b) informed consent (i.e., initiation of the device); and (c) end of life (i.e., deactivation of the device.) It is contended that, with the technological improvements in heart failure treatments and new indications, the decision making process for VAD placement and deactivation has become more clinically and ethically challenging, particularly for older adults. Areas for potential future research are identified.
authors.affiliation: Center for Medical Ethics & Health Policy, Baylor College of Medicine & The Methodist Hospital System, Houston, TX 77030, USA.
authors.forename: Courtenay R
authors.initials: CR
authors.lastname: Bruce
keywords: Ethics; heart failure; mechanical support; older adults; ventricular assist devices