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

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.