Ethical Withdrawal of ECMO Support Over the Objections of Competent Patients

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This article refers to:

From Bridge to Destination? Ethical Considerations Related to Withdrawal of ECMO Support over the Objections of Capacitated Patients

DISCLOSURE STATEMENT

John Fraser has acted as a consultant for De Motu Cordis, is employed by St Andrews War Memorial Hospital as Director of Intensive Care, and by Queensland Health as Director of the Critical Care Research Group, University of Queensland and the Prince Charles Hospital, Brisbane. He has received reimbursements from Disher and Paykel for travel and accommodation to attend medical conference, honoraria from PENN Medicine EMCO/MCS for Symposium keynote, and reimbursement from Gordon Research Institute for registration at Graft Preservation in Heart Transplantation. Julian Savulescu is an ethics consultant for Avon Cosmetics Ltd (2021–2023) and a Bioethics Committee consultant for Bayer.

Notes

1 We do not have space to address it here in detail, but psychological support for clinical teams in such circumstances is vital.

2 One of us has previously argued that withdrawal of life prolonging treatment is killing though it can be permissible (Persson and Savulescu 2005).

3 One practical point, is that patients with recurrent delirium in the ICU typically have worse prognosis than those patients whose sedation is able to be weaned.

4 Childress et al cite evidence on the cost-effectiveness of ECMO – indicating that in the adult CESAR randomised trial (of ECMO versus conventional support), its incremental cost fell within cost-effectiveness thresholds. However, this evidence cannot be applied to the question of the cost-effectiveness of providing ECMO to a patient who has no chance of survival without it and will require treatment for the rest of their life. A recent review identified, for US studies, that the daily cost of ECMO would be between a mean of $US 4600 and $11,500. If we assume that Mr J has full (normal) quality of life, the cost per quality adjusted ife year of his treatment is between $USD 1.4-4.1 million. https://link.springer.com/article/10.1007/s41669-021-00272-9

Additional information

Funding

This research was funded in whole, or in part, by the Wellcome Trust [203132/Z/16/Z]. The funders had no role in the preparation of this manuscript or the decision to submit for publication.