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

Rachael Alexis Jividen1, Paul J Ford2, Lauren Sankary3

  • 1Rachael Alexis Jividen is an acute care clinical nurse specialist and the Cleveland Clinic Health System extracorporeal life support program coordinator, Cleveland Clinic, Ohio.

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Summary

A structured framework aids ethical decision-making for extracorporeal membrane oxygenation (ECMO). This approach helps navigate complex patient care scenarios, ensuring decisions align with patient wishes and values.

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Area of Science:

  • Critical Care Medicine
  • Bioethics
  • Medical Ethics

Background:

  • Extracorporeal membrane oxygenation (ECMO) is a vital therapy presenting complex ethical dilemmas.
  • Challenges include patient selection, informed consent, benefit assessment, withdrawal, resource allocation, and moral distress.

Purpose of the Study:

  • To present a case study illustrating ethical challenges in ECMO.
  • To introduce and apply a novel Values Balancing framework for ethical decision-making in ECMO.

Main Methods:

  • A case study of a 50-year-old man with colorectal carcinoma undergoing ECMO.
  • Application of the Values Balancing framework to identify ethical issues, values, and courses of action.
  • Team-based review, reassessment, and reflection on outcomes.

Main Results:

  • Ethical issues involved limited physiological benefits, fluctuating decision-making capacity, and honoring patient preferences.
  • The Values Balancing framework facilitated structured ethical analysis and action planning.
  • The patient was transitioned to comfort care, honoring his wishes.

Conclusions:

  • A structured framework enhances ethical decision-making and collaboration in ECMO.
  • Critical care nurses play a key role in goals-of-care discussions and advocating for support services.
  • Early involvement of bioethics and palliative care optimizes ethical approaches to ECMO.