Implanted medical devices and end-of-life decisions

Abstract

If competent patients request that physicians participate in the deactivation of total artificial hearts and left ventricular assist devices, should physicians always comply? Patients and physicians currently have unsettled attitudes towards this question. I maintain that this issue is unsettling largely because the prospect of deactivation seems to give rise to a conflict between two deeply entrenched commitments of medical ethics: a commitment to the moral equivalency of withholding and withdrawing life-sustaining treatment, and a commitment to the prohibition on physicians' harming patients. I examine this apparent conflict and look at different ways of resolving it. I argue that the moral equivalency of withholding and withdrawing provides a decisive reason for physicians to participate in deactivation when a competent patient requests it, and that the prohibition on harming patients does not constitute a reason for physicians not to participate in deactivation. I also argue that an understanding of why it is acceptable for physicians to participate in deactivation reveals why physician-assisted death is morally acceptable in certain kinds of cases.