Mechanical cardiac support (MCS) devices started with pacemakers (PMs), expanded to intracardiac defibrillators (ICDs) and now include ventricular assist devices (VADs) as well as total artificial hearts (TAHs). While each has become accepted as therapy, deactivation requests from patients or appropriate surrogates have been less well received. Legal and ethical objections to deactivation have been raised with each device. It is reasonably well settled in the United States that deactivation of PMs and ICDs is an acceptable medical action. This consensus is based on respect for patient-centered determination of burdens and benefits of a therapy, which can change as the patient experiences life with the device as well as develops additional pathologies.

Recently, McIlvennan et al. reported on differing attitudes of cardiologists and palliative care specialists involved in the care of patients with VADs who have requested deactivation....

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