ECMO therapy renews ethical dilemmas about the limits of life sustaining treatment. Despite the magnitude of benefit this technology affords patients with life limiting pulmonary and cardiac disease, the perils of ECMO include the emergence of a subset of patients that do not have a destination treatment option and cannot be weaned from EMCO. Through the lens of one case this session will present the decisional challenges posed in the absence of clearly defined limits for halting ECMO when patients and surrogates do not agree to withdraw this life sustaining treatment. This session will explore the issues of harm, liminality, and the experiential interests of patients through the lens of nursing, medicine and clinical ethics. We will first outline the emotionally fraught challenges family members face seeing an awake, alert, rational person participate in relational activities that over time becomes normalized despite the invasive intensity of the treatment. Second, we will discuss the distress for healthcare providers who are compelled to maintain therapies when there are no defined limits or hard stops short of the patient or surrogate agreeing to halt ECMO. Third, the role of the clinical ethicist in these cases will be explored. We conclude with suggested parameters for limiting continuation of ECMO so it does not become a new destination treatment option.
Georgina Morley, PhD – Bioethicist, Center for Bioethics, Cleveland Clinic