Is It Ethically Justifiable to Withdraw Extracorporeal Membrane Oxygenation Against the Wishes of a Patient With Decision-Making Capacity When Cure Is Not Possible?
It is well established that clinicians may decline requests for inappropriate interventions, including life-prolonging interventions. This position is supported by major professional organizations,1,2 statutes and regulations,3 and case law.4 As such, the open question is whether providing extracorporeal membrane oxygenation (ECMO) may be considered inappropriate care when cure is not possible.
Physicians often place patients on extracorporeal membrane oxygenation (ECMO) support because they expect them either to recover with additional support or to become candidates for transplant or mechanical support. If these goals are not met, they may view continued ECMO support as medically inappropriate and recommend its withdrawal. In cases where decisionally-capacitated patients object to the withdrawal of ECMO support, it is not ethically justifiable to do so over their objections. I will offer four arguments supporting this claim based on considerations of medical futility, quality of life, nonmaleficence, and informed consent.