In the last decades, new technologies have improved the survival of patients affected by chronic illnesses. Among them, left ventricular assist device has represented a viable solution for patients with advanced heart failure. Even though the LVAD prolongs life expectancy, patients’ vulnerability generally increases during follow up and patients’ request for the device withdrawal might occur. Such a request raises some ethical concerns in that it directly hastens the patient’s death. Hence, in order to assess the ethical acceptability of LVAD (...) withdrawal, we analyse and examine an ethical argument, widely adopted in the literature, that we call the “descriptive approach”, which consists in giving a definition of life-sustaining treatment to evaluate the ethical acceptability of treatment withdrawal. Focusing attention on LVAD, we show criticisms of this perspective. Finally, we assess every patient’s request of LVAD withdrawal through a prescriptive approach, which finds its roots in the criterion of proportionality. (shrink)

BackgroundWith the increased use of implanted medical devices follows a large number of explantations. Implants are removed for a wide range of reasons, including manufacturing defects, recovery making the device unnecessary, battery depletion, availability of new and better models, and patients asking for a removal. Explantation gives rise to a wide range of ethical issues, but the discussion of these problems is scattered over many clinical disciplines.MethodsInformation from multiple clinical disciplines was synthesized and analysed in order to provide a comprehensive (...) approach to the ethical issues involved in the explantation of medical implants.ResultsDiscussions and recommendations are offered on pre-implantation information about a possible future explantation, risk–benefit assessments of explantation, elective explantations demanded by the patient, explantation of implants inserted for a clinical trial, patient registers, quality assurance, routines for investigating explanted implants, and demands on manufacturers to prioritize increased service time in battery-driven implants and to market fewer but more thoroughly tested models of implants.ConclusionSpecial emphasis is given to the issue of control or ownership over implants, which underlies many of the ethical problems concerning explantation. It is proposed that just like transplants, implants that fulfil functions normally carried out by biological organs should be counted as supplemented body parts. This means that the patient has a strong and inalienable right to the implant, but upon explantation it loses that status. (shrink)

Along with the growing utilization of the total artificial heart comes a new set of ethical issues that have, surprisingly, received little attention in the literature: How does one apply the criteria of irreversible cessation of circulatory function given that a TAH rarely stops functioning on its own? Can one appeal to the doctrine of double effect as an ethical rationale for turning off a TAH given that this action directly results in death? And, On what ethical grounds can a (...) physician turn off a TAH in view of the fact that either the intent of such an action or the outcome is always, and necessarily, death? The aim of this article is not to answer these questions but to highlight why these questions must be explored in some depth given the growing use of TAH technology. (shrink)

What makes something a part of my body, for moral purposes? Is the body defined naturalistically: by biological relations, or psychological relations, or some combination of the two? This paper approaches this question by considering a borderline case: the status of prostheses. I argue that extant accounts of the body fail to capture prostheses as genuine body parts. Nor, however, do they provide plausible grounds for excluding prostheses, without excluding some paradigm organic parts in the process. I conclude by suggesting (...) that embodiment is moralized all the way down: to be a body part is to be the sort of thing that ought to be protected, in a certain way, by social practices. (shrink)