Intrinsic Multiplicities: affective challenges in the ethics of left ventricular assist device deactivation
Saturday, October 14, 2023
7:30 AM – 8:45 AM ET
Location: Waterview CD (Lobby Level)
Despite ethical consensus from professional societies regarding left ventricular device (LVAD) deactivation, studies show significant discrepancies in physician opinion regarding the ethical and legal implications of LVAD deactivation. By drawing on existing literature regarding LVADs as life-sustaining measures, ontological differences between internality and externality in medical intervention, and the concept of biofixtures, we show that the tensions in LVAD deactivation arise from primarily affective challenges regarding the role of physicians’ actions in patient outcomes. Inspired by the philosophy of Gilles Deleuze, we argue that an analysis of multiplicity of the self and the constituent parts of the self can help resolve these tensions to better conceptualize ethical and affective unity in LVAD decision-making across disciplines. Such an analysis allows for a range of medical interventions to be understood as fundamentally altering yet continuing to be oriented toward ethical decision-making supportive of patient autonomy. Contextualizing LVAD deactivation within the context of withdrawal of life-sustaining measures more broadly allows for a situated, ethically defensible approach to these difficult yet common decisions.
Alexander Elnabli, PhD – Director, Operations, Parentis Health; Erik Larsen, PhD – Assistant Professor of Health Humanities and Bioethics, Health Humanities and Bioethics, University of Rochester School of Medicine and Dentistry