Health care is not a luxury in the sense of being an enjoyment or an unnecessary indulgence, but inequality and inaccessibility can make certain services seem like luxuries. Health equity means that everyone should have a fair opportunity to reach their full health potential and that no one should be disadvantaged because of factors like income, geography, ethnicity, gender, or social status. Equity in health care encompasses various interpretations and applications, as well as its use in concepts such as equity in access and adaptation of support to individual needs, including fairness in outcomes and financial affordability. Understanding equity’s multiple facets is crucial for designing effective programs and systems that promote fairness in health care services.

Equity in provision of extracorporeal membrane oxygenation (ECMO) is one of the most debated ethical and public health issues in critical care today. For a subset of critically ill patients ECMO is an essential lifesaving therapy. However, the high cost and resource requirements can make ECMO seem like a luxury when the access is limited, especially in regions without universal healthcare coverage.¹ From a health economics point of view, ECMO costs ranged in 2019 from US$22,305 to US$334,608 depending on the county and support indication.² The ECMO provision is expensive and resources intensive because of advanced equipment costs as well as it requires highly trained staff based on multidisciplinary teams including intensivists, nurses, perfusionist and ECMO specialists available 24/7.

In low- and middle-income countries, ECMO may indeed be seen as a luxury treatment that only the well-equipped hospitals or wealthier patients can access. This is where the term “luxury” becomes ethically charged. In public healthcare systems with limited resources, allocating ECMO to one patient might mean denying intensive care to several others. This debate became very visible during COVID-19 pandemics, when some countries restricted ECMO to specific prognosis criteria or even age to balance fairness and benefit. When resources are limited, ethical equity becomes even harder: should it be “first come, first served” or should the extracorporeal device go to those most likely to survive? or to younger patients? How to balance individual benefit versus population fairness?