“Death as the One Great Certainty”: ethical implications of children with irreversible cardiorespiratory failure and dependence on extracorporeal membrane oxygenation
IntroductionAdvances in medical technology have led to both clinical and philosophical challenges in defining death. Highly publicized cases have occurred when families or communities challenge a determination of death by the irreversible cessation of neurologic function (brain death). Parallels can...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2024-01-01
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| Series: | Frontiers in Pediatrics |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fped.2023.1325207/full |
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| author | Katie M. Moynihan Katie M. Moynihan Katie M. Moynihan Lisa S. Taylor Bryan Siegel Bryan Siegel Natasha Nassar Efrat Lelkes Wynne Morrison Wynne Morrison |
| author_facet | Katie M. Moynihan Katie M. Moynihan Katie M. Moynihan Lisa S. Taylor Bryan Siegel Bryan Siegel Natasha Nassar Efrat Lelkes Wynne Morrison Wynne Morrison |
| author_sort | Katie M. Moynihan |
| collection | DOAJ |
| description | IntroductionAdvances in medical technology have led to both clinical and philosophical challenges in defining death. Highly publicized cases have occurred when families or communities challenge a determination of death by the irreversible cessation of neurologic function (brain death). Parallels can be drawn in cases where an irreversible cessation of cardiopulmonary function exists, in which cases patients are supported by extracorporeal cardiopulmonary support, such as extracorporeal membrane oxygenation (ECMO).AnalysisTwo cases and an ethical analysis are presented which compare and contrast contested neurologic determinations of death and refusal to accept the irreversibility of an imminent death by cardiopulmonary standards. Ambiguities in the Uniform Determination of Death Act are highlighted, as it can be clear, when supported by ECMO, that a patient could have suffered the irreversible cessation of cardiopulmonary function yet still be alive (e.g., responsive and interactive). Parallel challenges with communication with families around the limits of medical technology are discussed.DiscussionCases that lead to conflict around the removal of technology considered not clinically beneficial are likely to increase. Reframing our goals when death is inevitable is important for both families and the medical team. Building relationships and trust between all parties will help families and teams navigate these situations. All parties may require support for moral distress. Suggested approaches are discussed. |
| first_indexed | 2024-03-08T14:49:21Z |
| format | Article |
| id | doaj.art-d173f771c3624fc3bebaed67b7536a22 |
| institution | Directory Open Access Journal |
| issn | 2296-2360 |
| language | English |
| last_indexed | 2024-03-08T14:49:21Z |
| publishDate | 2024-01-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Pediatrics |
| spelling | doaj.art-d173f771c3624fc3bebaed67b7536a222024-01-11T05:07:08ZengFrontiers Media S.A.Frontiers in Pediatrics2296-23602024-01-011110.3389/fped.2023.13252071325207“Death as the One Great Certainty”: ethical implications of children with irreversible cardiorespiratory failure and dependence on extracorporeal membrane oxygenationKatie M. Moynihan0Katie M. Moynihan1Katie M. Moynihan2Lisa S. Taylor3Bryan Siegel4Bryan Siegel5Natasha Nassar6Efrat Lelkes7Wynne Morrison8Wynne Morrison9Department of Pediatrics, Harvard Medical School, Boston, MA, United StatesDepartment of Cardiology, Boston Children’s Hospital, Boston, MA, United StatesChildren’s Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, AustraliaOffice of Ethics, Boston Children’s Hospital, Boston, MA, United StatesDepartment of Pediatrics, Harvard Medical School, Boston, MA, United StatesDepartment of Cardiology, Boston Children’s Hospital, Boston, MA, United StatesClinical and Population Translational Health, Children’s Hospital at Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, AustraliaDepartment of Pediatrics, MaineGeneral Medical Center, Augusta, ME, United StatesDepartment of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United StatesDivisions of Critical Care and Palliative Care, The Children’s Hospital of Philadelphia, Philadelphia, PA, United StatesIntroductionAdvances in medical technology have led to both clinical and philosophical challenges in defining death. Highly publicized cases have occurred when families or communities challenge a determination of death by the irreversible cessation of neurologic function (brain death). Parallels can be drawn in cases where an irreversible cessation of cardiopulmonary function exists, in which cases patients are supported by extracorporeal cardiopulmonary support, such as extracorporeal membrane oxygenation (ECMO).AnalysisTwo cases and an ethical analysis are presented which compare and contrast contested neurologic determinations of death and refusal to accept the irreversibility of an imminent death by cardiopulmonary standards. Ambiguities in the Uniform Determination of Death Act are highlighted, as it can be clear, when supported by ECMO, that a patient could have suffered the irreversible cessation of cardiopulmonary function yet still be alive (e.g., responsive and interactive). Parallel challenges with communication with families around the limits of medical technology are discussed.DiscussionCases that lead to conflict around the removal of technology considered not clinically beneficial are likely to increase. Reframing our goals when death is inevitable is important for both families and the medical team. Building relationships and trust between all parties will help families and teams navigate these situations. All parties may require support for moral distress. Suggested approaches are discussed.https://www.frontiersin.org/articles/10.3389/fped.2023.1325207/fullextracorporeal membrane oxygenation (ECMO)ethicscommunicationdeath & dyingpediatric |
| spellingShingle | Katie M. Moynihan Katie M. Moynihan Katie M. Moynihan Lisa S. Taylor Bryan Siegel Bryan Siegel Natasha Nassar Efrat Lelkes Wynne Morrison Wynne Morrison “Death as the One Great Certainty”: ethical implications of children with irreversible cardiorespiratory failure and dependence on extracorporeal membrane oxygenation Frontiers in Pediatrics extracorporeal membrane oxygenation (ECMO) ethics communication death & dying pediatric |
| title | “Death as the One Great Certainty”: ethical implications of children with irreversible cardiorespiratory failure and dependence on extracorporeal membrane oxygenation |
| title_full | “Death as the One Great Certainty”: ethical implications of children with irreversible cardiorespiratory failure and dependence on extracorporeal membrane oxygenation |
| title_fullStr | “Death as the One Great Certainty”: ethical implications of children with irreversible cardiorespiratory failure and dependence on extracorporeal membrane oxygenation |
| title_full_unstemmed | “Death as the One Great Certainty”: ethical implications of children with irreversible cardiorespiratory failure and dependence on extracorporeal membrane oxygenation |
| title_short | “Death as the One Great Certainty”: ethical implications of children with irreversible cardiorespiratory failure and dependence on extracorporeal membrane oxygenation |
| title_sort | death as the one great certainty ethical implications of children with irreversible cardiorespiratory failure and dependence on extracorporeal membrane oxygenation |
| topic | extracorporeal membrane oxygenation (ECMO) ethics communication death & dying pediatric |
| url | https://www.frontiersin.org/articles/10.3389/fped.2023.1325207/full |
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