Bioethics Blogs

Beyond the Destination LVAD

There are many forms of life sustaining treatment available
to patients thanks to advances in medical technology. When a person’s
physiology weakens or fails, devices may be attached or implanted to take over
for organs that can no longer bear the workload of processing, moving, or
taking in the elements needed to keep a body alive. Conceptually, this is
appealing to a society that is as averse to death as are those of us here in
the US. But we still struggle to accommodate the range of needs that crop up
when function is compromised. As an ethicist, the general trend in my work
suggests that the more advanced the technology, the more questions it raises
when it comes time to talk about halting the mechanical support. Among the more
advanced tools for sustaining physiological function is the Left Ventricular
Assist Device, or LVAD, which maintains the circulatory function for persons
with severe heart failure.

There is little doubt that individuals who are eligible for
the device can experience remarkable quality of life gains whether they move on
to receive a heart transplant or receive the implant as a destination
treatment. Recipients of LVADs can typically return to their daily activities,
and enjoy a level of independence not previously possible for persons with
otherwise lethal heart conditions. However, these patients are not just like
everyone else when complications arise. Decisions about how best to manage long
term care for persons who have LVADs can be unexpectedly complex, most notably
when the patient lives outside a major metropolitan city center.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.