Authors: Withdrawing LVAD support permissible

Patients have the right to refuse or request the withdrawal of any unwanted treatment, and in an online article published in the Mayo Clinic Proceedings, investigators explore the legal and ethical permissibility of carrying out such a request specific to a ventricular assist device (VAD).

The LVAD provides circulatory support for patients with severe heart failure who are awaiting a heart transplant. It can serve as a long-term treatment option for patients who are not candidates for heart transplant, but still need circulatory support. And while the technology is improving, some patients experience complications, such as strokes, related to their treatment or underlying disease and request withdrawal of VAD support.

In their study, Paul Mueller, lead investigator, Mayo Clinic Department of General Internal Medicine, and his colleagues describe 14 patients at Mayo Clinic, Rochester, MN, from March 1, 2003, through Jan. 31, 2009, who requested (or whose surrogates requested) withdrawal of VAD support. 

The authors state patients have the right to refuse or request the withdrawal of any unwanted treatment, and this right extends to VAD support. Furthermore, because underlying heart disease is the cause of death--not assisted suicide or euthanasia--requesting the withdrawal of VAD support "is permissible in accordance with the principles that apply to withdrawing other life-sustaining treatments," according to the study abstract.

"Assuming the patient (or surrogate) is informed regarding alternatives to and consequences of withdrawing VAD support, clinicians should carry out such requests or transfer the patient's care to another physician," the authors write.

- read the Mayo clinic release
- check out the Mayo study abstract