Thursday, April 24, 2008

Surgically implanted heart pumps can create ethical dilemmas at different levels

Rob Stein has an important front page story today in The Washington Post, April 24, 2008, “Heart Pump Creates Life-Death Ethical Dilemmas,” link here The story concerns the surgically implanted heart pump, which is sometimes a bridge treatment until a heart transplant is found, or is sometimes an end treatment, possibly in conjunction with or after coronary bypass surgery, to add some years of life. The devices have external batteries, microprocessors and wiring leading into the body cavity to control the pump. The treatment has mixed results, working well for some patients but causing serious complications (infections, clots, strokes) and deterioration in others. It appears that in some cases the surgery should not be done unless other family members are willing to be supportive of a possibly risky, disruptive and uncertain surgery.

Here is a typical article from the American Heart Association, “Smaller heart pump bridges time to transplant for more women” from 11/04/2007, link here. It seems that many of the operations are done earlier, in the 50s and 60s. It isn’t clear how well the operation can work repeatedly in later decades.

The Post story considers the ethical dilemmas, in cases where patients want the pumps turned off in end-of-life situations. There is a risk that some people could live very long times with very poor quality and in extreme dependence, when in some cases they might have been more self-sufficient (even with shorter final life spans) without surgery.

When I was a "buddy" in the 1980s for the Dallas Oak Lawn Counseling Center AIDS Project, we would hear talk of patients' "letting go." That talk went away as the medications got better and victims, relatively young, not only survived much longer but went back to work and no longer needed daily services.

But, for the elderly, medicine has gotten much better at prolonging life than at prolonging vigor.

No comments: