Dick Cheney, who has had four heart attacks, relies on a device called a left ventricular assist device to help keep the blood pumping through his veins. Ironically, it is tax-payer funded research that led to the development of the device.

Written by Arthur Caplan for Scienceprogress.org

Last July former Vice President Dick Cheney had a left ventricular assist device (LVAD) put into his chest to assist his failing heart. Cheney is now resuming his public life in politics. News reports note that he is more than willing to talk about his new life-saving implant. It is not so clear that he fully understands what he needs to say about it.

There is a lot to talk about regarding LVADs. As Cheney resumes his active role in GOP politics, is he aware that the only reason he is alive is as a result of taxpayer-supported government research at the National Institutes of Health? He might want to mention that the private sector did not do the basic research that led to the invention of the LVAD—public money played the crucial role.

The left ventricular assist devices are used when a heart is no longer capable of pumping blood on its own and cannot recover. Those who receive them will die with them. Which leads to another topic Cheney should be talking about—how he will die.

LVADs are the direct legacy of the program to build a total artificial heart that was instituted at NIH more than 50 years ago. While a total artificial heart proved difficult to create, partial artificial hearts were designed and actively used in government-financed research trials by the late 1990s. While the newly empowered GOP is saber-rattling about huge cuts in government spending, without federal funding for NIH, Cheney would be very unlikely to be alive to join that chorus.

While Cheney’s LVAD is clearly keeping him alive and active, things will not always be so positive. LVADs have a lot of frequent complications including a high risk of infection, device failure, and blood clots. Any of these can cause mental impairment in addition to a high risk of death.

So it is important that the former vice president and anyone else with an LVAD have a conversation with their doctor about end-of-life planning. While politically it has proven difficult to keep a financial incentive in place in Obamacare to encourage this conversation, it is crucial that those who are dependent upon a last ditch technology like an LVAD talk about their wishes and values with their doctors and their families.

Dick Cheney has spent his life combating the untoward influence of big government on individual freedom and as a critic of many nondefense federal programs. Ironically, it is federal spending that created the machine that allows him to continue to push his point of view. And it is the very program he and the GOP have condemned as “death panels” that provides the best hope that he will enjoy the kind of death he chooses. He and the rest of us must do whatever we can to encourage advance care planning as part of our routine medical care.

Arthur Caplan, PhD, is the Director of the Center for Bioethics and the Sidney D Caplan Professor of Bioethics at the University of Pennsylvania.