Ethical Dilemmas in Therapy Withdrawal

This chapter explores the concept of therapy withdrawal on heart failure and offers guidance for the resolution of ethical dilemmas that can occur in such situations. It introduces burdens, benefits, and futility. It also deals with the patient's treatment preferences. It then covers surrogate decisionmaking and the termination of implantable interventions, specifically the termination of pacemaker, defibrillators, ventricular assist devices, and total artificial heart. All therapies, whether implantable or not, should be regularly evaluated to ascertain their burdens and the patient's capacity to benefit from them. Patients with decision-making capacity should be routinely invited to comment on their quality of life, as well as their health-care goals. When advance directive documentation exists, it should be reviewed by the health-care team and decision-making surrogates. All treatment decisions should reflect the burdens, benefits, and values of the patient or the patient's best interests when discrete values are unknown.