Clarification and Mitigation of Ethical Problems Surrounding Withdrawal of Extracorporeal Membrane Oxygenation.
Extracorporeal membrane oxygenation (ECMO) is temporary life-support technology that provides time to rest the cardiac and respiratory system of critically ill people with acute, reversible medical conditions. Health care providers face emotional and challenging situations, where death may result, when withdrawing ECMO. A deepening of understanding of the ethical issues involved can aid clinicians in handling such difficult situations, leading to a possible mitigation of the moral problems. Toward this end, the ethical issues raised in the consideration of ECMO withdrawal are analyzed with respect to the ethical principles and concepts of autonomy, nonmaleficence/beneficence, medical futility, moral distress, and justice. In particular, these issues are considered in relation to how they affect and can be addressed by staff nurses and advanced practice nurses in the intensive care unit. Advanced practice nurses in particular can represent the voice of nurses to promote a healthier workplace in situations of moral distress related to stopping ECMO life-support technology and in developing clear and consistent guidelines for ceasing ECMO treatment, all leading toward clarification and mitigation of the ethical problems surrounding the withdrawal of this critical technology.
Susan B. Williams is an expert intensive care nurse and clinical specialist in extracorporeal membrane oxygenation who worked for 25 years in the newborn/infant intensive care unit at The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.Michael Dahnke is a bioethicist and adjunct instructor in the School of Nursing at the College of New Rochelle, New Rochelle, New York, and adjunct instructor in the philosophy department at the College of Staten Island, New York, New York.
Susan B
SB
Williams
Susan B. Williams is an expert intensive care nurse and clinical specialist in extracorporeal membrane oxygenation who worked for 25 years in the newborn/infant intensive care unit at The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.Michael Dahnke is a bioethicist and adjunct instructor in the School of Nursing at the College of New Rochelle, New Rochelle, New York, and adjunct instructor in the philosophy department at the College of Staten Island, New York, New York. mdahnke@cnr.edu.
Michael D
MD
Dahnke
D000066491:Clinical Decision-Making / Q000941:ethics*; D003422:Critical Care / Q000379:methods; D064648:Critical Care Nursing / Q000941:ethics / Q000379:methods; D016638:Critical Illness / Q000401:mortality / Q000628:therapy; D015199:Extracorporeal Membrane Oxygenation / Q000941:ethics* / Q000379:methods / Q000401:mortality; D005260:Female; D006801:Humans; D008020:Life Support Care / Q000941:ethics* / Q000379:methods; D008297:Male; D017063:Outcome Assessment, Health Care; D026684:Personal Autonomy; D017009:Professional Autonomy; D014481:United States; D028761:Withholding Treatment / Q000941:ethics*