Fairly Distributing the Distributive Justice Argument Permits Stopping ECMO

“Death as the One Great Certainty”: ethical implications of children with irreversible cardiorespiratory failure and dependence on extracorporeal membrane oxygenation

“…Recent ethical analyses focus on withdrawal of ECMO in awake adolescents/adults over their dissent which is uncommon in pediatric ECMO ( 16 – 19 , 56 ). A comprehensive exploration of pediatric ethical issues using varying ethical frameworks and lenses is critical to ensure that rationales for decisions are robustly constructed ( 17 , 18 , 23 , 55 – 57 ).…”

“…The best interest standard is also applied differently internationally; in the US, clinicians typically override parental authority only if parental decisions cause substantial/significant harm to the child, while in some countries medical authority is given more priority ( 62 , 64 , 65 ). Resource limitations, however, may change this calculus as the impacts on other potential patients or the healthcare system affect what it is appropriate to provide for any individual ( 23 ). When death is unavoidable and proximate, does discontinuation of circulatory support fall within the zone of parental discretion or harm?…”

“…Healthcare professionals also have a duty to society. The extensive resources utilized in ECMO—beds, personnel, blood, medication, finances—are limited ( 23 ). ECMO is also a therapy with inequitable access ( 69 , 70 ).…”

“…ECMO is also a therapy with inequitable access ( 69 , 70 ). When perceived to be not clinically beneficial, when death is imminent, continued utilization of ECMO then becomes unjust in a society where healthcare is a finite resource ( 23 , 26 ). Providers have stewardship obligations—to be judicious in the use of these therapies, and thus discontinue ECMO when death is inevitable ( 26 ).…”