New research brings to light a question of ethics when it comes to the deactivation of a left ventricular assist device (LVAD). Concerns differ significantly between cardiologists, hospice, and palliative medicine clinicians. This has lead to inconsistent and confusing end-of-life care for some patients, according to a new study in the Journal of Cardiac Failure.
A Gap in Ethical Perspectives
Research has shown that around 13% of cardiologists consider LVAD deactivation as a type of euthanasia. While, none of the hospice and palliative care respondents ascribed to this thinking. In addition, 60% of cardiologists believed a patient should be “dying” before deactivating the LVAD. Only 2% of hospice and palliative care staff used the same standard.
“Our study highlights several LVAD-specific situations that cardiology and HPM clinicians view differently, chief among them whether a patient should be imminently dying or not to honor one’s request for LVAD deactivation,” wrote lead author Colleen K. McIlvennan, DNP, ANP, and colleagues. “This type of fundamental difference of opinion can create inconsistent care for patients—leading to confusion for patients, loved ones, and other health care providers.”
Researchers interpreted their findings from 391 people who completed a survey The group included cardiology clinicians, physicians, nurse practitioners as well as physician assistants and hospice and palliative care. The study included quantitative and qualitative comparisons of clinicians in both specialties. A sample of survey responses accompanied the results, shedding light on a gap in ethical perspectives.
In the study, 26 percent of cardiologists and 59 percent of hospice and palliative care clinicians said they would be “comfortable” personally turning off the device. The same percentage of cardiologists indicated they would be comfortable just ordering the deactivation, compared to 92 percent of hospice and palliative care respondents.
In the U.S. an LVAD is considered a life support treatment, not unlike a ventilator. Patients or their power of attorneys are allowed to request deactivation. If a clinician doesn’t support that decision, should they transfer care to someone who can carry out the patient’s wishes.
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