The Total Artificial Heart: Conclusion
It is likely that patients will be incapable of directly participating in the final decision to turn off a TAH. Advance termination agreements, like living wills or durable powers of attorney, could be used as part of the consent process to provide “relief from the continued beating of the artificial heart” just as they are now used in other settings. These directives should be constructed to protect health care providers from adverse legal action as they act to carry out the patients wishes. Such agreements should be reviewed periodically with the patient after the TAH has been implanted.
With the patients permission, termination planning should be conducted jointly with the designated proxy decision-maker. Patients should use durable powers of attorney to name family proxies to act in the patients interests if the patient is unable to participate in decisions. Such joint planning and proxy designations should prove helpful to families in the stressful time when the patient becomes incompetent. The medical chart should record the proxy’s participation in this process. In most jurisdictions, this process would provide significant legal protection for the physician and the institution where the TAH is used. there
The TAH poses ethical and public policy issues that are as formidable as the scientific and technical difficulties of TAH development. The task at hand is to develop effective therapies for patients dying prematurely of cardiac failure. The relative shortage of donor hearts will lead to continued interest in the TAH both as a permanent device and as a form of pre-transplantation management despite criticisms of this device. For public policy, the most pressing need is for an innovative policy to responsibly deploy the TAH as a bridge to transplant. For clinicians, the principles of consent and for advance planning for possible termination of the TAH are similar to those developed for other life support technologies.