Ethical Challenges and Implications of Deactivating Mechanical Circulatory Support for Patients With Preserved Cognitive Function

Activity Summary

Required reading for all learners: Implicit Bias impacts patient outcomes

The advent of Mechanical Circulatory Support (MCS) has made it possible for patients with end-stage heart failure to move even farther along the disease trajectory. What prevails are increasingly complex clinical cases, which challenge both the limits of medical and mechanical management as well as our attitudes surrounding [medical futility/patient autonomy and the ‘locus of decisional authority’ when it comes to end-of-life decision-making. Maintaining space for patient autonomy, can be challenging, especially with respect to deactivation of MCS in cardiac patients who are cognitively intact. Despite the rigors of informed consent and a steadfast commitment by the surgeon and care team to uphold the implicit care contract, the decision to deactivate or withdraw mechanical support rests with the patient. Nurses play a pivotal role in safeguarding patient autonomy and supporting surgeons and care teams in accepting and upholding these difficult choices.

Objectives

Identify steps nurses can take to facilitate an ethically minded approach to decision-making for patients with mechanical circulatory support (MCS).
Reflect on your role as a nurse in assisting care teams to honor a patient’s desire to discontinue mechanical therapies.
Define the process of informed consent as it pertains to the process of informed decision-making.

Continuing Education Disclosure Statement

Successful Completion

Learners must attend/view/read the entire activity and complete the associated evaluation to be awarded the contact hours or CERP. No partial credit will be awarded.

Disclosure

This activity has been reviewed by the Nurse Planner. It has been determined that the material presented here shows no bias. No conflicts of interest have been identified for any individual with the ability to influence the content of this activity. Accreditation refers to recognition of continuing education only and does not imply AACN or ANCC approval or endorsement of any commercial products discussed or displayed in conjunction with this educational activity.

Accreditation

The American Association of Critical-Care Nurses (AACN) is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's (ANCC's) Commission on Accreditation, ANCC Provider Number 0012. AACN has been approved as a provider of continuing education in nursing by the California State Board of Nursing (CBRN), California Provider number CEP 1036. This activity is approved for 1.00 contact hours.

AACN programming meets the standards for most states that require mandatory continuing education contact hours for license and/or certification renewal. AACN recommends consulting with your state board of nursing or credentialing organization before submitting CE to fulfill continuing education requirements.

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Continuing Education Activities are nonrefundable.