Mitigating ethical conflict and moral distress in the care of patients on ECMO: Impact of an automatic ethics consultation protocol

M. Jeanne Wirpsa*, Louanne M. Carabini, Kathy Johnson Neely, Camille Kroll, Lucia D. Wocial

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Aims: This study evaluates a protocol for early, routine ethics consultation (EC) for patientson extracorporeal membrane oxygenation (ECMO) to support decision-making in the context of clinicaluncertainty with the aim of mitigating ethical conflict and moral distress. Methods: We conducted asingle-site qualitative analysis of EC documentation for all patients receiving ECMO support from 15 August 2018 to 15 May 2019 (n=68). Detailed analysis of 20 ethically complex cases with protracted ethics involvement identifies four key ethical domains: limits of prognostication, bridge to nowhere, burden of treatment and system-level concerns. There are three subthemes: relevant contextual factors, the role of EC and observed outcomes. Content analysis of transcripts from interviews with20 members of the multidisciplinary ECMO team yields supplemental data on providers' perceptions ofthe impact of the early intervention protocol. Results: Limited outcome data for ECMO, unclear indications for withdrawal, adverse effects of treatment and an obligation to attend to programme metrics present significant ethical challenges in the care of this patient population. Upstream EC mitigates ethical conflict by setting clear expectations about ECMO as a time limited trial, promoting consistent messaging among multiple services and supporting surrogate decision-makers. When ECMO becomes a € bridge to nowhere', EC facilitates decision-making that respects patient values yet successfully sets limits on non-beneficial use of this novel therapy. Conclusion: Data from this study support the conclusion that ECMO poses unique ethical challenges that necessitate a standardised protocol for early, routine EC - at least while this medical technology is in its nascent stages.

Original languageEnglish (US)
JournalJournal of Medical Ethics
StateAccepted/In press - 2021


  • clinical ethics
  • decision-making
  • end of life care
  • ethics
  • ethics committees/consultation

ASJC Scopus subject areas

  • Issues, ethics and legal aspects
  • Health(social science)
  • Arts and Humanities (miscellaneous)
  • Health Policy


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