Depression, Capacity, and a Request to Discontinue Life-Sustaining Treatment.

A. M. Pena
American Journal of Bioethics (2015); 15(7): 70-1.

The Right to Refuse Life Sustaining Treatment

There is ethical and legal consensus that a patient has the right to refuse life-sustaining treatment (LST), as an expression of autonomy-based principles, when the patient demonstrates an appropriate degree of capacity, the decision is consistent with the patient's preferences and free from coercion, and when the burdens exceed the benefits of continued treatment.  For the purposes of this discussion, I assume that the left ventricular assistance device (LVAD) is a form of LST and that it may be ethically permissible to deactivate the device, which is largely in accordance with professional and ethical consensus.  As with other forms of LST, if the device is deactivated, then the patient would die from underlying physiological causes, namely, heart disease.  My objective for this commentary, however, is to discuss whether depression can impair capacity to the extent that it is an ethical contraindication for withdrawing LST.

The article is here.