**9. Ethical and palliative care considerations**

In patients with heart failure, the end of life is due to failure of the pumping function of the heart. In patients with an LVAD, the end of life is typically due to a complication of their devices. Palliative care providers need to be familiar with these complications to treat their symptoms. Goals of life should be addressed prior to implantation. An LVAD is a heavy burden for the patient and their family and the true cost for all those who will be involved needs to be discussed. Families often need assistance with conversations to determine what their loved one would want once they are no longer able to communicate for themselves and this should be established prior to implantation. It should also be discussed that when choosing comfort care, turning off an LVAD does not equate to assisted death and may or may not lead to an immediate death. It can happen at any location with hospice guidance. Depression in the setting of a high healthcare burden is common and should be monitored and treated [55].

*LVAD Continuing Care: A Comprehensive Guide to Long-Term Support and Management DOI: http://dx.doi.org/10.5772/intechopen.114271*

Patients and families without long-term comorbidities have a lower perceived treatment burden [56]. A thorough evaluation of capacity and discussion on all LVAD challenges should occur prior to implantation. While this may not always be possible in emergent situations, the realization of lifestyle changes, recurring hospitalizations, or lack of symptom improvement post-implantation can create an ethical dilemma [57]. Patients have a right to refuse medical care and request LVAD deactivation when that is their desire. Physicians of record should provide resources to respect a patient's wishes in the hospital or at home [58].
