Is Left Ventricular Assist Device Deactivation Ethically Acceptable? A Study on the Euthanasia Debate

Roggi, Sara; Picozzi, Mario

doi:10.1007/s10730-020-09408-6

Cited by 4 publications

(3 citation statements)

References 38 publications

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“…Once the patient has received information from the physician, together they render the proportionality judgment explicit by evaluating whether to confirm the decision to accept. 59 , 60 …”

Section: Resultsmentioning

confidence: 99%

“…Once the patient has received information from the physician, together they render the proportionality judgment explicit by evaluating whether to confirm the decision to accept. 59,60 In the logic of the criterion of proportionality, at the end of the process, the patient and the physician decide together. Although the physician should not shy away from giving the patient his or her opinion (ie, the physician does not hold a neutral position), 61 it is recommended that physicians do not dwell in their own risk aversion when offering NSRD organs to their patient(s).…”

Section: Time 3-time Of the Organ Offer: The Time To Confirm The Deci...mentioning

confidence: 99%

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The 3-T Model of Informed Consent for Nonstandard Risk Donors: A Proposal for Transplant Clinical Practice

Grossi

Nicoli

Feo

et al. 2021

Transplantation Direct

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Background. The risk of disease transmission from nonstandard risk donors (NSRDs) is low, and outcomes are similar or better relative to transplants performed with standard criteria donors. However, NSRDs have posed new ethical challenges to the informed consent (IC) process. Based on the shared decision-making model, coinciding with the 3 main timings of the IC process ([1] pretransplant assessments and waiting list registration, [2] time on the waiting list, and [3] time of the organ offer), we put forward a model (3-T Model) to summarize the knowledge on IC for NSRDs and to deliver conceptual and practical support to transplant providers on this emergent issue. Methods. We searched PubMed and analyzed data from our area to provide evidence and ethical arguments to promote standardization of the timing of patient information, degree of patient participation, and disclosure of donor risk factors throughout the 3 stages of the time continuum leading to the potential acceptance of NSRDs. Results. Each of the 3 timings carries special ethical significance and entails well-defined duties for transplant providers relative to patient involvement and information of the benefits and risks associated with NSRDs. Based on our framework, experience, and interpretation of the literature, we put forward a list of recommendations to combine standardization (ie, timing, content, and degree of patient participation) and individualization of IC. Conclusions. The 3-T Model may enable the prevention of physicians’ arbitrariness and the promotion of patient-centered care. Future studies will assess the effectiveness of the 3-T Model in transplant clinical practice.

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“…Once the patient has received information from the physician, together they render the proportionality judgment explicit by evaluating whether to confirm the decision to accept. 59 , 60 …”

Section: Resultsmentioning

confidence: 99%

Section: Time 3-time Of the Organ Offer: The Time To Confirm The Deci...mentioning

confidence: 99%

The 3-T Model of Informed Consent for Nonstandard Risk Donors: A Proposal for Transplant Clinical Practice

Grossi

Nicoli

Feo

et al. 2021

Transplantation Direct

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“…Recalling the role of relationships on people's identity, as mentioned above, it is necessary to carefully evaluate the role that time, understood as "lived time" (Kairos), and not only as "chronological time" (Kronos), plays in decisionmaking, especially when it is necessary to decide for others. This involves recognizing that time has a bearing on the patient's perception of his illness and treatment and, in our case, on that of his family members' as well and on how it affects their choices [47]. If, as we have already mentioned, making decisions on behalf of someone else calls into question the person who makes the decision, the passing of time (Kronos) affects his identity and changes the meaning of treatment.…”

Section: Time Of Illness and Time Of Carementioning

confidence: 97%

Analyzing the paradigmatic cases of two persons with a disorder of consciousness: reflections on the legal and ethical perspectives

Picozzi

Panzeri

Torri³

et al. 2021

BMC Med Ethics

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Background Media have increasingly reported on the difficulties associated with end-of-life decision-making in patients with Disorders of Consciousness (DOC), contextualizing such dilemma in detailed accounts of the patient’s life. Two of the first stories debated in the scientific community were those related to the cases of two women, one American, the other Italian, who captured attention of millions of people in the first years of this third millennium. Methods Much has been written about the challenges of surrogate decision-making for patients in DOC, but less has been written comparing these challenges across legal systems and cultures. In our paper, we propose a systematic analysis of the final legal documents written by the American and Italian Courts in relation to the two cases, developing our discussion around three areas: the level of certainty/reliability of diagnosis and prognosis, the reconstruction of self-expression, time of illness and time of care. They are examples of the typical issues discussed by legal authors and allow us to understand the link and the difference between the legal and ethical perspectives. Results The legal approach to the two cases has some common elements: the need to be certain about the diagnosis and prognosis and the fact that the clinical criteria are necessary in determining the most appropriate treatments, although these criteria are not sufficient unless they are supplemented by the patient’s will. The issue of relations takes on importance both from a legal and an ethical point of view, but from two different perspectives. While ethics safeguards relationships by guaranteeing their differences and makes them reconcilable, law safeguards relationships by guaranteeing the cold forms of respect, equality, impartiality, symmetry, reciprocity, and irreversibility. In this perspective, the link between the time of care and the decision of the family members assumes importance. Conclusions The most interesting point that emerges from our analysis is the issue of relationships and how they affect decisions, both from a legal and ethical point of view. For this reason, during the patients’ hospitalization, it is necessary to identify ways in which they might give their opinion about the moral issues underlying their choices.

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The experiences among bereaved family members after a left ventricular assist device (LVAD) deactivation

Kelemen,

Groninger,

Yearwood

et al. 2024

Heart & Lung

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Is Left Ventricular Assist Device Deactivation Ethically Acceptable? A Study on the Euthanasia Debate

Cited by 4 publications

References 38 publications

The 3-T Model of Informed Consent for Nonstandard Risk Donors: A Proposal for Transplant Clinical Practice

The 3-T Model of Informed Consent for Nonstandard Risk Donors: A Proposal for Transplant Clinical Practice

Analyzing the paradigmatic cases of two persons with a disorder of consciousness: reflections on the legal and ethical perspectives

The experiences among bereaved family members after a left ventricular assist device (LVAD) deactivation

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