Ethical Analysis of Extracorporeal Membrane Oxygenation Using the Values Balancing Framework: A Case Study

Extracorporeal membrane oxygenation is a life-sustaining therapy that can produce complex ethical scenarios. Ethical challenges include patient selection and initiation, a frequently abbreviated informed consent process, ambiguity related to ongoing benefit and withdrawal of extracorporeal membrane oxygenation, resource intensity, and moral distress.

A 50-year-old man with mucinous colorectal carcinoma was admitted to the hospital. He encountered treatment complications and received cannulation for extracorporeal membrane oxygenation twice during his stay. Ethical issues included the potentially limited physiological benefits of extracorporeal membrane oxygenation, fluctuations in his decision-making capacity, and need to ensure that decisions honored his preferences.

A novel Values Balancing framework is used to identify and address ethical issues, possible courses of action, applicable values, open questions, other perspectives, and ethically supportable courses of action. With this framework, an action plan is established and the team is encouraged to review, reassess, and reflect on outcomes. The framework is applied to the case study.

The patient was transitioned to comfort care according to his wishes and died in the intensive care unit.

Using a structured framework to approach ethical challenges may facilitate decision-making and collaborative discussions that optimize ethical approaches to extracorporeal membrane oxygenation. Critical care nurses can assist with goals-of-care discussions, support families, and advocate for early involvement of bioethics and palliative support personnel to navigate ethical challenges.