Medical Assistance in Dying in Patients With Destination-Therapy Left Ventricular Assist Devices.

BACKGROUND

Published experience with medical assistance in dying (MAiD) in patients receiving durable left ventricular assist device (LVAD) support is limited, with no prior Canadian reports.

CASE SUMMARY: Two male patients with destination-therapy LVADs received clinician-administered MAiD. One had refractory transfusion-dependent gastrointestinal bleeding and died in a community hospice; the other had refractory pain, anxiety, and existential suffering and died on an acute care ward. In both cases, intravenous medications were administered while the LVAD remained active, and the device was deactivated after unconsciousness and apnea were confirmed. No procedural complications occurred.

DISCUSSION: These cases describe a practical approach to coordinating MAiD with LVAD deactivation in hospital and hospice settings. The process required advance agreement among the LVAD team, MAiD provider, and palliative care team regarding medication sequencing, responsibility for device deactivation, and anticipated alarms.