Heart Pump Creates Life-Death Ethical Dilemmas

Simon declined to reveal additional details about the patient he dubbed "Mr. P," but he said Mr. P could turn off the device himself or let the batteries run out.

"Mr. P is presumably uncomfortable with the options because they seem to him like suicide," Simon wrote. "The fact that the patient does not want to take action on his own, however, does not authorize others to hasten his death for him."

Others are also uneasy.

"Our normal intuition is that it's illegal and probably immoral to actively kill someone," said Robert M. Veatch, a Georgetown University bioethicist. "If you think about stopping the left ventricular assist device as something like stopping the heart, then you have to deal with the possibility that this is an active killing."

One partial solution would be for doctors to avoid implanting the devices in those who are too old or too sick.

"There's definitely some patients who have LVADs who should not have received them," said Bramstedt, the bioethicist at the California Pacific Medical Center. "Sometimes when you put these in, the patient actually gets worse. And now they are in limbo, hooked up to this machinery."

Surgeons who implant the devices argue that doctors are getting better at choosing recipients.

"Our first mission as physicians is to do no harm," said Robert L. Kormos, director of the Artificial Heart Program at the University of Pittsburgh Medical Center.

In the meantime, more doctors are discussing the possibility of turning off the devices so patients know that palliative care is available, and doctors and family know what the patient would want if they become incapacitated and further care is futile.

Still, patients have been found with the devices detached from the power source, raising the possibility that they disconnected them without thinking that doctors could help them die.

Said Rodney Tucker, medical director of the palliative care center at the University of Alabama at Birmingham: "I don't think we've seen the full spectrum of how we'll deal with these devices in the long-term. The technology is still in its infancy. Whenever you have technology in its infancy, that technology will inevitably have some falls."