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Ann Thorac Surg 2006;81:1185-1188
© 2006 The Society of Thoracic Surgeons

Ethics in cardiothoracic surgery

Ethics Guidelines for Destination Therapy

Denise M. Dudzinski, PhD, MTS *

University of Washington Medical Center, University of Washington School of Medicine, Seattle, Washington

* Address correspondence to Dr Dudzinski, University of Washington Medical Center University of Washington School of Medicine, A204 HSC, Box 357120, Seattle, WA 98195-7120 (Email: denise.dudzinski{at}u.washington.edu).

The introduction of the left ventricular assist device as a destination therapy for patients with heart failure introduces several ethical issues. These issues are discussed to help destination therapy teams design ethically sound policies and procedures. This article addresses ethical issues pertaining to informed decision making, device failure, and change out, as well as guidelines for deactivation, fair employment of medical and psychosocial criteria, the nature of destination therapy as an elective end-of-life therapy, and advance care planning strategies.






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