Cardiologists need to become more familiar with these devices' limitations, too:
We have to address what is the meaning of death on one of these pumps," said Dr. Valluvan Jeevanandam, chief of cardiac and thoracic surgery at the University of Chicago Medical Center and an investigator for Thoratec's clinical trials.Like pacemakers and ventillators, these devices intervene on the natural course of the dying process and when the quality of life declines sufficiently after their use, it is ethical for patients and family members to request such support be withdrawn.
Roughly 70 percent of patients on the HeartMate II were alive after a year, and nearly 60 percent were alive after two years, according to the latest data.
"It's not hard to imagine a person who has had severe stroke that has impacted both sides of the brain, the kidneys are shutting down, he is on a respirator, but yet the LVAD just keeps churning along," said Martin Smith, a clinical ethicist at the Cleveland Clinic.
Under U.S. law, patients are allowed to ask that implanted devices be turned off. But Dr. Diane Meier, a professor in the department of geriatrics and palliative medicine at the Mount Sinai School of Medicine, said cardiologists are particularly bad at preparing patients for death, especially this kind of death.
The challenge, of course, is what to do when these members of the care team aren't there...
-Wes
2 comments:
Alas, one of the provisions of healthcare reform that was universally derided as the death panel was intended to help with this. Having patients and/or family aware of their options when near death is critical education that needs to take place across the public continuum.
The more we can do (like LVADs), the more complicated medical decisions get.
When, and for how long to unleash the fury of medicine continues to challenge.
Then, there is the obvious…which sits in front of the cardiologist, but often remains unseen.
Well said.
JMM
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