TY - JOUR
T1 - The Ethics of Extracorporeal Membrane Oxygenation
T2 - Revisiting the Principles of Clinical Bioethics
AU - Enumah, Zachary Obinna
AU - Carrese, Joseph
AU - Choi, Chun Woo
N1 - Funding Information:
Dr Enumah receives salary support through a National Institutes of Health Ruth L. Kirschstein National Research Service Award T32 Appointment (5T32AR067708-05, PI: Clemens, T.).
Publisher Copyright:
© 2021 The Society of Thoracic Surgeons
PY - 2021/7
Y1 - 2021/7
N2 - Background: Extracorporeal life support has become accepted as a rescue therapy for cardiopulmonary shock, and there have been over 100,000 extracorporeal membrane oxygenation (ECMO) cases since 1987. Rapid growth has presented ethical challenges and concerns. Here, we discuss core principles of bioethics in an attempt to more thoroughly appreciate the ethical concerns and considerations raised by use of this technology. Methods: An extensive literature review was performed on current papers on ECMO and ethics. In this paper, we utilized 3 case studies to highlight 4 major tenets of bioethics as they relate to use of ECMO: autonomy, beneficence, nonmaleficence, and justice. Results: Case studies presented involved unique perspectives on utilization of ECMO and a careful balance of benefits and harms as they relate to autonomy, beneficence, nonmaleficence and justice. We present nuanced interpretations of autonomy (eg, physician autonomy) and justice (eg, various providers interpret and offer ECMO differently). An additional challenge includes contending with potentially prolonged clinical courses and/or complications that either result directly from cannulation for ECMO or indirectly from being subject to ensuing extreme conditions and prolongation of life that medical science has yet to fully understand. Conclusions: ECMO programs continue to grow in number and capacity. A deep appreciation of the bioethical dimensions of this technology and its application must be pursued, understood and applied to individual patient scenarios.
AB - Background: Extracorporeal life support has become accepted as a rescue therapy for cardiopulmonary shock, and there have been over 100,000 extracorporeal membrane oxygenation (ECMO) cases since 1987. Rapid growth has presented ethical challenges and concerns. Here, we discuss core principles of bioethics in an attempt to more thoroughly appreciate the ethical concerns and considerations raised by use of this technology. Methods: An extensive literature review was performed on current papers on ECMO and ethics. In this paper, we utilized 3 case studies to highlight 4 major tenets of bioethics as they relate to use of ECMO: autonomy, beneficence, nonmaleficence, and justice. Results: Case studies presented involved unique perspectives on utilization of ECMO and a careful balance of benefits and harms as they relate to autonomy, beneficence, nonmaleficence and justice. We present nuanced interpretations of autonomy (eg, physician autonomy) and justice (eg, various providers interpret and offer ECMO differently). An additional challenge includes contending with potentially prolonged clinical courses and/or complications that either result directly from cannulation for ECMO or indirectly from being subject to ensuing extreme conditions and prolongation of life that medical science has yet to fully understand. Conclusions: ECMO programs continue to grow in number and capacity. A deep appreciation of the bioethical dimensions of this technology and its application must be pursued, understood and applied to individual patient scenarios.
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U2 - 10.1016/j.athoracsur.2020.08.045
DO - 10.1016/j.athoracsur.2020.08.045
M3 - Article
C2 - 34159900
AN - SCOPUS:85109059457
SN - 0003-4975
VL - 112
SP - 61
EP - 66
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 1
ER -