Abstract
Extracorporeal membrane oxygenation (ECMO) is typically viewed as a time-limited intervention—a bridge to recovery or transplant—not a destination therapy. However, some patients with decision-making capacity request continued ECMO support despite a poor prognosis for recovery and lack of viability as a transplant candidate. In response, critical care teams have asked for guidance regarding the ethical permissibility of unilateral withdrawal over the objections of a capacitated patient. In this article, we evaluate several ethical arguments that have been made in favor of withdrawal, including distributive justice, quality of life, patients’ rights, professional integrity, and the Equivalence Thesis. We find that existing justifications for unilateral withdrawal of ECMO support in capacitated patients are problematic, which leads us to conclude that either: (1) additional ethical arguments are necessary to defend this approach or (2) the claim that it is not appropriate to use ECMO as a destination therapy should be questioned.
ACKNOWLEDGMENTS
We would like to thank our colleagues at the Center for Medical Ethics and Health Policy with whom we spent many hours discussing ethical issues related to ECMO support. In particular, we would like to thank Savitri Fedson, Claire Horner, and Adam Peña for sharing their insights and comments. We would also like to thank the anonymous reviewers whose thoughtful comments and recommendations greatly improved this article.
DISCLOSURE STATEMENT
None of the authors have conflicts of interest to disclose.