Ethics in cardiothoracic surgeryRevisiting Surrogate Consent for Ventricular Assist Device Placement
Section snippets
Complexities Involved in Using Surrogate Consent for VAD placement
Surrogate decision making for VAD placement is challenging for several reasons. First, most patients are unfamiliar with VADs and likely never discussed this technology with their families [6]. Thus, a surrogate's ability to accurately represent a patient's wishes and goals for VAD placement may be constrained. Surrogates are widely (if not universally) used to make decisions about life-sustaining technologies for patients who lack decision-making capacity. This is because a surrogate's
Ethical Safeguards
Heart failure programs should recognize the possibility (and ethical and legal permissibility) of deactivating devices if or when patients regain decision-making capacity and decide that their resulting quality of life is unsatisfactory. Regardless of the initial intended purpose (DT or bridge-to-transplant) and the consenter authorization (patient or surrogate) for VAD placement, continued use is justified only when its short-term goal (prolonging life) and long-term goal (preserving for the
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