Parole chiave
LVAD
Four-boxes method
Proportionality
Abstract
Background
Life-saving technologies have completely changed the normal conception of medical treatments. Left Ventricular Assist Devices (LVAD) can prolong survival for patients who are not candidates for heart transplantation. In order to analyze the pre-implantation phase, which involves a shared-decision making process before activation of the device, attention should be paid to the criterion of “proportionality” in order to properly assess the risks and benefits of implantation.
Aim
The aim of our analysis is to provide an useful tool for the assessment of LVAD proportionality during the physicians’ decision making.
Methods
The method of the “four boxes”, developed by Jonsen et al, was chosen to analyze the notion of proportionality and the other main ethical issues regarding LVAD activation in adult patients.
Results
Medical issues are not the sole factors, which influence the choice of implantation by patients. Indeed, patient preferences, his/her quality of life, and contextual features should be taken into consideration when proposing LVADs: these factors are as important as clinical issues where outcomes are concerned.
Conclusion
In order to assess the proportionality of such a device, we present, discuss and examine, in the framework of the pre-implant phase, the content of each topic treated by the “four boxes method”, that is, an essential tool for the assessment of the proportionality of the treatment for LVAD candidates.