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Cited by 29Ethics and Legal Issues in Pediatric HealthcareEthics and bioethics in healthcareEthics in medical practice

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Ethics in extracorporeal life support: a narrative review

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Schou, Alexandra, Mølgaard, Jesper, Andersen, Lars Willy, Holm, Søren, Sørensen, Marc·2021·Critical Care
DOI 10.1186/s13054-021-03689-0PMC PMC8293515
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Abstract

During 50 years of extracorporeal life support (ECLS), this highly invasive technology has left a considerable imprint on modern medicine, and it still confronts researchers, clinicians and policymakers with multifarious ethical challenges. After half a century of academic discussion about the ethics of ECLS, it seems appropriate to review the state of the argument and the trends in it. Through a comprehensive literature search on PubMed, we identified three ethical discourses: (1) trials and evidence accompanying the use of ECLS, (2) ECLS allocation, decision-making and limiting care, and (3) death on ECLS and ECLS in organ donation. All included articles were carefully reviewed, arguments extracted and grouped into the three discourses. This article provides a narrative synthesis of these arguments, evaluates the opportunities for mediation and substantiates the necessity of a shared decision-making approach at the limits of medical care.

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  • Family members frequently serve as surrogate decision-makers for critically ill patients, navigating emotionally charged decisions under severe time constraints.

    “In practice, family members frequently serve as surrogate decision-makers, navigating emotionally charged decisions that balance survival probabilities, quality of life, financial feasibility, and ethical considerations under severe time constraints11.”

    From Decisional conflict among Chinese family caregivers prior to ECMO initiation: a cross-sectional study (2025) · cites this paper as [11]

    The Decision-making section (page not provided) says surrogates may find weighty decisions overwhelming and identifies emotional distortion, urgency, and prognostic uncertainty as obstacles to informed consent. It does not say that family members frequently act as surrogates. The Resource allocation section discusses costs and insurance coverage, but does not present financial feasibility as something family surrogates balance in these decisions. (LLM, conf=0.86)

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Metadata

Authors
Schou, A., Mølgaard, J., Andersen, L. W., Holm, S., & Sørensen, M.
Affiliations
  • Aalborg University Hospital (DK)
  • Copenhagen University Hospital (DK)
  • University of Manchester (GB)
Corresponding author
Sørensen, Marc
ORCID
Venue
Critical Care
Publisher
Springer Science and Business Media LLC
Published
2021-07-21
Volume
25
Issue
1
Pages
256-256
ISSN
1364-8535 (ISSN-L)
DOI
10.1186/s13054-021-03689-0
PMC
PMC8293515
OpenAlex
W3185772542
Cited by
29
References
0
Citations by year
2026: 4 · 2025: 8 · 2024: 11 · 2023: 1 · 2022: 4
FWCI
0.97
Type
journal article
Language
en
Open access
Licence
Locations
  • Critical Care (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Research Explorer (The University of Manchester) (publishedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • VBN Forskningsportal (Aalborg Universitet) (submittedVersion, cc-by)
Topics
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Ethics and Legal Issues in Pediatric Healthcare
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
  • Health Sciences › Health Professions › General Health Professions › Ethics in medical practice
Keywords
extracorporeal life support, medical ethics, end-of-life decisions, withholding and withdrawing life-sustaining treatment, organ donation, shared decision-making
MeSH terms
Ethics, Medical, Humans, Respiratory Insufficiency, Risk Factors, Extracorporeal Membrane Oxygenation, History, 20th Century

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