Ethical issues in palliative care in heart failure

Manuel Martínez-Sélles is Head of Section of Cardiology of the Hospital General Universitario Gregorio Marañón, and Professor in the Universidad Europea and Universidad Complutense, Madrid, Spain. Here, he explains the background to a longer article published in the January/February issue of the European Journal of Palliative Care.

Professor Manuel Martínez-Sélles

The recent progress in the treatment of heart failure is outstanding (Ponikowski et al) but carries an increased ethical complexity in the care of these patients. As part of the work of the European Association for Palliative Care and Heart Failure Association of European Cardiac Society Joint Task Force on Palliative Care for People with Heart Disease, we present a review of the ethical issues in the palliative care of people with heart failure, with a multidisciplinary perspective, including cardiologists, palliative care experts, and ethicists from different European countries.

Advanced heart failure is a life-shortening condition and planning for adverse events and the end of life should be integrated during early phases of the illness. In our opinion, communication is essential to inform about benefits and burdens of interventions and to understand patient goals and values. The prognostication of the disease progression for individual patients with heart failure is difficult, as there is no ‘typical’ dying trajectory. A regular revisiting during the process of the disease is necessary to allow adjustment to changing circumstances. Loss of functional capacity or autonomy may occur gradually or abruptly and sudden death is a frequent event.

We think that the involvement of patients and families in different types of decision-making is essential and should include new treatment options, withdrawal of ongoing therapy, resuscitation status, use of palliative sedation, and other end-of-life decisions. Social and spiritual support is extremely important, as is legislation knowledge. Patients with implanted devices, including implantable cardioverter-defibrillators and ventricular assist devices, merit special attention and it is essential to identify situations in which the devices may need to be deactivated (Daeschler et al).

References

Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GM, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P; Authors/Task Force Members. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail. 2016 Aug; 18 (8): 891-975.

Daeschler M, Verdino RJ, Kirkpatrick JN. The ethics of unilateral implantable cardioverter defibrillators and cardiac resynchronization therapy with defibrillator deactivation: patient perspectives. Europace. 2016 Dec 2. pii: euw227. [Epub ahead of print]

Read the full article in the European Journal of Palliative Care

Or download your free copy of this article from the EAPC website.

This post relates to a longer article, ‘Reflections on ethical issues in palliative care for patients with heart failure’ by Dr Manuel Martínez-Sélles, Pablo Díez Villanueva, Ruthmarijke Smeding, Bernd Alt-Epping, Daisy Janssen, Carlo Leget, Marta Albert, Agustin Losada, Piotr Sobanski, David Oliver published in the January/February 2017 edition of the European Journal of Palliative Care (vol. 24.1).

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Read more posts relating to articles published in the European Journal of Palliative Care on the EAPC Blog. 

EJPC Palliative Care Development Award 2017 – nominations form now online.

Do you know someone who has made a major contribution to palliative care policy development? Why not nominate them for the EJPC Palliative Care Policy Development Award? Click here to nominate. Launched by the European Journal of Palliative Care in collaboration with the European Association for Palliative Care, the award is aimed at professionals working in palliative care worldwide who have made a substantial contribution to policy development through research, clinical practice or as policy activists. The 2017 Award will be presented at the 15th World Congress of the EAPC in Madrid, Spain (18–20 May 2017.Deadline for applications: 31 March 2017.