The Total Artificial Heart and the Dilemma of Deactivation

Abstract

ABSTRACT. It is widely believed to be permissible for a physician to discontinue any treatment upon the request of a competent patient. Many also believe it is never permissible for a physician to intentionally kill a patient. I argue that the prospect of deactivating a patient's artificial heart presents us with a dilemma: either the first belief just mentioned is false or the second one is.Whichever horn of the dilemma we choose has significant implications for contemporary medical ethics. INTRODUCTIONNew technology can lead us to reconsider old principles. The total artificial heart is one such technology, and the principles are two:( DISCONTINUATION ) It is permissible for a physician to discontinue any treatment upon the request of a competent patient.( PROHIBITION ) It is never permissible for a physician to intentionally kill a patient.DISCONTINUATION enjoys wide support within the medical community. PROHIBITION is controversial-as shown by the debates over euthanasia-but also enjoys considerable support.

Getting Real About Killing and Allowing to Die: A Critical Discussion of the Literature

“…So unauthorized WLT can be consistently classified as killing rather than as letting die, as the identity of moral agents influences how an act is classified and is morally significant (30,31). 26 Bronner (32) provides an analysis against the standard view in the context of novel medical technologies that is resistant to critiques proposed by McGee and others (33). Focusing on the concrete case of deactivating a total artificial heart (DAH), Bronner argues that the standard view cannot accommodate DAH, even if it can accommodate other forms of WLT.…”

“…Sulmasy's account of intentions appeals to the notion of "commitment": a physician can foresee and even desire that a patient should die quickly after WLT and yet not intend the patient's death because they are not committed to the death as the condition that fulfills their intention (19, p.59). 32 Whether or not an agent is committed to an outcome (e.g., death) in this way can be tested by asking such questions as, "If the patient's death did not take place, would you consider your action to have failed? Would you try some other way to bring about their death?"…”

“…We return to Miller and Truog's approach in the second section of the paper. 32 In response to the second line of objection noted above, Sulmasy's account offers an explanation of how it is possible to know (even with certainty or near certainty) that one's action will produce an effect and yet not intend that effect. 33 Biggar argues that beyond the effect of our actions on the world outside ourselves we must also consider the "subjective, reflexive impact on the agent… of his will's commitment, through intention, to a right or wrong act" (49, p.67).…”