Replying to Veatch's concerns: Special moral problems with total artificial heart inactivation

Moral problems arise when contemplating the inactivation of total artificial heart technology: however, an ethical obligation to explant the device as part of therapy withdrawal is not one of them. Further, arguments will be presented justifying that inactivation of the device is not morally equivalent to active killing of the patient. When device inactivation is clinically and ethically warranted, this decision should not be unilaterally made by the physician but through thorough discussion with the patient (if possible), the patient's surrogate, and the medical team. Consultation with legal counsel and the hospital ethics committee may also be appropriate.