From Bridge to Destination? Ethical Considerations Related to Withdrawal of ECMO Support over the Objections of Capacitated Patients

Am J Bioeth. 2023 Jun;23(6):5-17. doi: 10.1080/15265161.2022.2075959. Epub 2022 May 26.


Extracorporeal membrane oxygenation (ECMO) is typically viewed as a time-limited intervention-a bridge to recovery or transplant-not a destination therapy. However, some patients with decision-making capacity request continued ECMO support despite a poor prognosis for recovery and lack of viability as a transplant candidate. In response, critical care teams have asked for guidance regarding the ethical permissibility of unilateral withdrawal over the objections of a capacitated patient. In this article, we evaluate several ethical arguments that have been made in favor of withdrawal, including distributive justice, quality of life, patients' rights, professional integrity, and the Equivalence Thesis. We find that existing justifications for unilateral withdrawal of ECMO support in capacitated patients are problematic, which leads us to conclude that either: (1) additional ethical arguments are necessary to defend this approach or (2) the claim that it is not appropriate to use ECMO as a destination therapy should be questioned.

Keywords: Decision-making; end of life issues; futility; moral theory; professional ethics.

MeSH terms

  • Critical Care
  • Dissent and Disputes
  • Extracorporeal Membrane Oxygenation* / adverse effects
  • Humans
  • Patients
  • Quality of Life