Ethical Dilemmas Surrounding ECMO Withdrawal: A Qualitative Empirical Study

Extracorporeal membrane oxygenation (ECMO) is a critical, life-sustaining intervention often described as 'a bridge to nowhere' due to its transient nature and the ethical complexities it entails. This qualitative empirical study examines the moral dilemmas surrounding ECMO utilization in clinical practice, with a particular focus on the unilateral withdrawal of support for capacitated patients with a poor prognosis.

Using a qualitative, thematic analysis of existing literature, we performed a literature search in PubMed with ECMO and ethical principles as search concepts. We reviewed 139 articles for possible inclusion, where articles were included if they discussed the ethical dilemmas or implications of unilateral ECMO withdrawal. The patient's condition did not also play a role in the selection of eligible arguments.

We found that in the context of pandemics, the shortage of ECMO machines for a growing number of critically ill patients placed significant pressure on ethical evaluations, with concerns involving distributive justice, quality of life, patients' rights, and professional integrity. The paper systematically analyzed the ethics of resource allocation, the impact on patient autonomy, and the role of palliative care, highlighting the intricacies of the Equivalence Thesis in decision-making. Furthermore, it critically explored the foundational principles, such as beneficence and non-maleficence, and proportionality, alongside other ethical concepts discussed in the literature, like professional and legal considerations.

By analyzing these ethical dimensions, this paper seeks to inform and shape evidence-based, patient-centered policies and practices in ECMO management, fostering decisions that respect both the rights of patients and the ethical duties of clinicians.