PerspectiveWithdrawing extra corporeal membrane oxygenation (ECMO) against a family's wishes: Three permissible scenarios
Section snippets
Crisis medicine
The first argument for unilateral withdrawal of ECMO is most intuitive: when institutions implement crisis standards of medicine. Crisis standards require a shift in focus from providing a physiologically beneficial intervention from single patient to another patient, based on the perceived needs of the larger group.1, 2, 3 When crisis standards are in place, unilaterally withdrawing any medical intervention, including ECMO, can be ethically permissible.4, 5, 6, 7 Institutions should have
Conclusion
We have provided 3 scenarios where it is ethically permissible to unilaterally withdraw ECMO. Our arguments, while novel in their setting and specificity, apply established consensus positions to the specifics of withdrawing ECMO. We hope that ECMO programs will evaluate these arguments and reflect on their applicability. Without a programmatic approach, discrete team members may be willing withdraw ECMO when others may not, increasing the likelihood of variation, unfair access, and low-quality
Author contributions
T.M.B.: Conceptualized the manuscript, drafted the manuscript, edited the manuscript; A.Z.: Participated in conceptualizing the manuscript, edited the manuscript.
Disclosure statement
The authors have no conflicts of interest to disclose.
Thanks to Dr Divina Tuazon, Dr Erik Eddie Suarez, and Dr Howard Huang for initial conversation about this project.
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