Abstract
Refusal of treatment can have fatal consequences for heart failure patients who could
otherwise benefit from ventricular assist device therapy. Ethical dilemmas arise when
treatment refusals seem based on unsound reasoning by patients. Using a clinical case
from our medical center, we explored the complex ethical issues associated with patient
refusal of ventricular assist device therapy due to the patient’s perception of large
device size as compared to other mechanical heart technologies. Early on, the medical
team must assess a patient’s refusal of therapy by reflecting on the decisionmaking
capacity of the patient to determine whether such refusal is truly “informed,” and
all incidents of informed refusal should be clearly documented in the patient’s chart.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The Journal of Heart and Lung TransplantationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Obtaining informed consent.Arch Intern Med. 1969; 123: 682-688
- Should informed consent be based on rational beliefs?.J Med Ethics. 1997; 23: 282-288
- The best interests of incompetent patients.Calif Law Rev. 1988; 76: 897-937
- The Bartling case.J Am Geriatr Soc. 1986; 34: 44-48
- Refusal of implantable cardioverter defibrillator generator replacement.Focus Crit Care. 1992; 19: 97-100
- First Turkish experience with the MicroMed DeBakey VAD.Tex Heart Inst J. 2003; 30: 114-120
- Can the patient decide? Evaluating patient capacity in practice?.Am Fam Physician. 2001; 64: 299-306
- Ethical opinion E-2.035 futile care. 1994; (Chicago, June)
- When competent patients make irrational choices.N Engl J Med. 1990; 322: 1595-1599
Article info
Publication history
Accepted:
October 28,
2003
Received in revised form:
October 27,
2003
Received:
August 8,
2003
Identification
Copyright
© 2005 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.
