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Medical Ethics |

Challenges in Deactivating a Total Artificial Heart for a Patient With CapacityDeactivating a Total Artificial Heart

Courtenay R. Bruce, JD; Nathan G. Allen, MD; Bridget N. Fahy, MD; Harvey L. Gordon, MD; Erik E. Suarez, MD; Brian A. Bruckner, MD
Author and Funding Information

From the Center for Medical Ethics & Health Policy (Prof Bruce and Drs Allen, Fahy, and Gordon), and Section of Emergency Medicine (Dr Allen), Department of Medicine, Baylor College of Medicine; The Methodist Hospital System (Prof Bruce and Drs Allen, Fahy, and Gordon), The Methodist Hospital System Ethics Program; Department of Surgery (Dr Fahy), Weill Cornell Medical College, Methodist Hospital; Division of Palliative Medicine (Dr Fahy), The Methodist Hospital; Methodist DeBakey Heart and Vascular Center and JC Walter Jr Transplant Center (Drs Suarez and Bruckner); and Texas Heart Institute (Dr Bruckner), St. Luke’s Episcopal Hospital, Houston, TX.

Correspondence to: Courtenay R. Bruce, JD, Center for Medical Ethics & Health Policy, Baylor College of Medicine, One Baylor Plaza, MS: BCM 420, Houston, TX 77030; e-mail: crbruce@bcm.edu


An abstract of this study was presented at the International Society of Heart and Lung Transplantation Annual Meeting and Scientific Sessions, Montreal, Quebec, Canada, April 2013 and published in abstract form (Suarez E, Bruce C, Gordon HL, Loebe M, Bunge RR, Bruckner BA. J Heart Lung Transpl. 2013;32(4):S286).

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;145(3):625-631. doi:10.1378/chest.13-1103
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The use of mechanical circulatory support (MCS) devices has increased sixfold since 2006. Although there is an established legal and ethical consensus that patients have the right to withdraw and withhold life-sustaining interventions when burdens exceed benefits, this consensus arose prior to the widespread use of MCS technology and is not uniformly accepted in these cases. There are unique ethical and clinical considerations regarding MCS deactivation. Our center recently encountered the challenge of an awake and functionally improving patient with a total artificial heart (TAH) who requested its deactivation. We present a narrative description of this case with discussion of the following questions: (1) Is it ethically permissible to deactivate this particular device, the TAH? (2) Are there any particular factors in this case that are ethical contraindications to proceeding with deactivation? (3) What are the specific processes necessary to ensure a compassionate and respectful deactivation? (4) What proactive practices could have been implemented to lessen the intensity of this case’s challenges? We close with a list of recommendations for managing similar cases.


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