Department of Anesthesiology

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

TitleShould Long-Term Life-Sustaining Care Be Started in Emergency Settings?
Publication TypeJournal Article
Year of Publication2019
AuthorsMeltzer EC, Ivascu NS, Edwin MK, Ingall TJ
JournalAMA J Ethics
Volume21
Issue5
PaginationE401-406
Date Published2019 May 01
ISSN2376-6980
Abstract

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.

DOI10.1001/amajethics.2019.401
Alternate JournalAMA J Ethics
PubMed ID31127919