Erin S DeMartino1, Sara E Wordingham2, John M Stulak3, Barry A Boilson4, Kayla R Fuechtmann5, Nausheen Singh6, Daniel P Sulmasy7, Octavio E Pajaro8, Paul S Mueller9. 1. Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN. 2. Division of Hematology and Medical Oncology, Mayo Clinic Hospital, Phoenix, AZ. 3. Division of Cardiovascular Surgery, Mayo Clinic, Rochester, MN. 4. Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN. 5. Augsburg College, Minneapolis, MN. 6. University of Wisconsin, Madison. 7. MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, IL. 8. Division of Cardiovascular and Thoracic Surgery, Mayo Clinic Hospital, Phoenix, AZ. 9. Division of General Internal Medicine, Mayo Clinic, Rochester, MN. Electronic address: mueller.pauls@mayo.edu.
Abstract
OBJECTIVES: To describe the characteristics of patients who undergo withdrawal of total artificial heart support and to explore the ethical aspects of withdrawing this life-sustaining treatment. PATIENTS AND METHODS: We retrospectively reviewed the medical records of all adult recipients of a total artificial heart at Mayo Clinic from the program's inception in 2007 through June 30, 2015. Management of other life-sustaining therapies, approach to end-of-life decision making, engagement of ethics and palliative care consultation, and causes of death were analyzed. RESULTS: Of 47 total artificial heart recipients, 14 patients or their surrogates (30%) requested withdrawal of total artificial heart support. No request was denied by treatment teams. All 14 patients were supported with at least 1 other life-sustaining therapy. Only 1 patient was able to participate in decision making. CONCLUSION: It is widely held to be ethically permissible to withdraw a life-sustaining treatment when the treatment no longer meets the patient's health care-related goals (ie, the burdens outweigh the benefits). These data suggest that some patients, surrogates, physicians, and other care providers believe that this principle extends to the withdrawal of total artificial heart support.
OBJECTIVES: To describe the characteristics of patients who undergo withdrawal of total artificial heart support and to explore the ethical aspects of withdrawing this life-sustaining treatment. PATIENTS AND METHODS: We retrospectively reviewed the medical records of all adult recipients of a total artificial heart at Mayo Clinic from the program's inception in 2007 through June 30, 2015. Management of other life-sustaining therapies, approach to end-of-life decision making, engagement of ethics and palliative care consultation, and causes of death were analyzed. RESULTS: Of 47 total artificial heart recipients, 14 patients or their surrogates (30%) requested withdrawal of total artificial heart support. No request was denied by treatment teams. All 14 patients were supported with at least 1 other life-sustaining therapy. Only 1 patient was able to participate in decision making. CONCLUSION: It is widely held to be ethically permissible to withdraw a life-sustaining treatment when the treatment no longer meets the patient's health care-related goals (ie, the burdens outweigh the benefits). These data suggest that some patients, surrogates, physicians, and other care providers believe that this principle extends to the withdrawal of total artificial heart support.
Authors: Paul S Mueller; Keith M Swetz; Monica R Freeman; Kari A Carter; Mary Eliot Crowley; Cathy J Anderson Severson; Soon J Park; Daniel P Sulmasy Journal: Mayo Clin Proc Date: 2010-06-28 Impact factor: 7.616
Authors: Jack G Copeland; Richard G Smith; Francisco A Arabia; Paul E Nolan; Gulshan K Sethi; Pei H Tsau; Douglas McClellan; Marvin J Slepian Journal: N Engl J Med Date: 2004-08-26 Impact factor: 91.245