Should Long-Term Life-Sustaining Care Be Started in Emergency Settings?

AMA J Ethics. 2019 May 1;21(5):E401-406. doi: 10.1001/amajethics.2019.401.


Decision making on behalf of an incapacitated patient is challenging, particularly in the context of venoarterial extracorporeal membrane oxygenation (VA-ECMO), a medically complex, high-risk, and costly intervention that provides cardiopulmonary support. In the absence of a surrogate and an advance directive, the clinical team must make decisions for such patients. Because states vary in terms of which decisions clinicians can make, particularly at the end of life, the legal landscape is complicated. This commentary on a case of withdrawal of VA-ECMO in an unrepresented patient discusses Extracorporeal Life Support Organization guidelines for decision making, emphasizing the importance of proportionality in a benefits-to-burdens analysis.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Decision Making / ethics*
  • Emergency Service, Hospital / ethics*
  • Extracorporeal Membrane Oxygenation / ethics*
  • Extracorporeal Membrane Oxygenation / methods
  • Humans
  • Male
  • Practice Guidelines as Topic
  • Risk Assessment
  • Tachycardia, Ventricular / diagnosis
  • Terminally Ill
  • Third-Party Consent / ethics*
  • Third-Party Consent / legislation & jurisprudence*
  • Withholding Treatment / ethics*