When Technology Meets Its Limits: Integrating Medical Aid in Dying With Withdrawal of a Left Ventricular Assist Device.

Many patients in the United States live with left ventricular assist devices - surgically implanted mechanical pumps that support circulation in individuals with advanced heart failure. The use of these devices has grown steadily, with new implants performed each year and many patients maintained with ongoing longitudinal care. As outcomes improve and patients live longer with this form of mechanical support, clinicians across disciplines are increasingly confronted with the complex clinical, ethical, and practical challenges that arise when life-sustaining therapy is dependent on implanted technology, particularly in the context of end-of-life decision-making. We present a case report of a 76-year-old man with advanced heart failure supported by an implanted cardiac pump. He pursued medical aid in dying - the legal process by which a terminally ill, mentally capable adult may take prescribed medications to end their life. Deactivating a cardiac assist pump typically occurs in a hospital with intravenous sedation for the abrupt heart failure symptoms that can occur when the pump is turned off. But this patient desired to die at home. An end-of-life care navigator and a carefully assembled interdisciplinary team providing medical aid in dying in conjunction with pump deactivation achieved the patient's home death at his selected date. Coordinating implanted cardiac device withdrawal with medical aid in dying is clinically achievable, ethically defensible, and legally sound. Healthcare systems must develop written protocols, train hospice providers, provide anticipatory counseling, fund necessary infrastructure, and support this end-of-life care.