Advanced Cardiopulmonary Care Ethics

Advanced cardiopulmonary care technologies, such as ventricular assist devices and extracorporeal membrane oxygenation, suggest the importance of considering whether, when, and for how long they should be used. These life-sustaining therapies can postpone certain death, reshape our views about what should be considered good end-of-life care, and prompt examination of what clinicians’ roles might be in patients’ experiences of death.  

Volume 21, Number 5: E373-474 Full Issue PDF
  • From the Editor
    May 2019

    When Clinical Advances Outpace Ethics

    Elizabeth A. Sonntag, MD
    When weighing potential benefits of technological advancement against risks of harm, clinicians should prioritize duties to patients.
    AMA J Ethics. 2019;21(5):E375-379. doi: 10.1001/amajethics.2019.375.
  • Case and Commentary
    May 2019

    How Should Physicians Respond to Requests for LVAD Removal?

    Larry A. Allen, MD, MHS
    Patients have a right to decline or withdraw LVADs. Informed consent and shared decision making is not easy, however, with treatments that are high risk, high reward.
    AMA J Ethics. 2019;21(5):E394-400. doi: 10.1001/amajethics.2019.394.
  • Case and Commentary
    May 2019

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

    Ellen C. Meltzer, MD, MSc, Natalia S. Ivascu, MD, Mark K. Edwin, MD, and Timothy J. Ingall, MBBS, MD, PhD
    Extracorporeal Life Support Organization guidelines emphasize proportionality and benefit/risk analyses in decision making.
    AMA J Ethics. 2019;21(5):E401-406. doi: 10.1001/amajethics.2019.401.
  • Medicine and Society
    May 2019

    Palliative Care for Patients on Mechanical Circulatory Support

    Sara E. Wordingham, MD and Colleen K. McIlvennan, DNP, ANP
    Palliation goals should inform MCS therapy duration, symptom management, and advance care planning and facilitate communication.
    AMA J Ethics. 2019;21(5):E435-442. doi: 10.1001/amajethics.2019.435.
  • History of Medicine
    May 2019

    Will We Code for Default ECMO?

    Daniel J. Brauner, MD and Christopher J. Zimmermann, MD
    CPR has become default treatment for all patients in cardiac arrest. The history of how this happened demonstrates the power of CPT coding.
    AMA J Ethics. 2019;21(5):E443-449. doi: 10.1001/amajethics.2019.443.
  • Art of Medicine
    May 2019

    Sustaining the Lives of Art Objects

    Sarah Molina
    Caring for the Art Institute of Chicago’s collection suggests the importance of cultural humility in museums and in medicine.
    AMA J Ethics. 2019;21(5):E450-454. doi: 10.1001/amajethics.2019.450.
  • Art of Medicine
    May 2019

    Fading Mind of a Patient With Alzheimer’s

    Laci Hadorn
    This artwork represents—via a puzzle—physical and emotional experiences of brain deterioration.
    AMA J Ethics. 2019;21(5):E455-456. doi: 10.1001/amajethics.2019.455.
  • Art of Medicine
    May 2019

    Moral Distress Containment Through an Artist’s and Art Psychotherapist’s Lens

    Georgina Morley, PhD, MSc, RN and Annie Sharon Fox, MA
    This series of 3 paintings of figures in a bath explores emotional responses of persons experiencing or responding to others’ moral distress. Intricately tied together and connected through time and space, the bodies represented suggest a complex web of relationships between clinicians and patients.
    AMA J Ethics. 2019;21(5):E457-460. doi: 10.1001/amajethics.2019.457.
  • Personal Narrative
    May 2019

    How Can We Make Out-of-Hospital CPR More Family Centered?

    Caroline Mawer, MRCGP, MBBS, MSc, MFPH
    Linda’s story suggests ways to take better care of terminally and chronically ill patients at home by listening in different ways.
    AMA J Ethics. 2019;21(5):E461-469. doi: 10.1001/amajethics.2019.461.
  • Viewpoint
    May 2019

    How Should One Live Everlasting Life?

    Rachel F. Harbut
    Life extension requires careful consideration of resource scarcity, justice, and what, if anything, is intrinsic to the experiences we define as human.
    AMA J Ethics. 2019;21(5):E470-474. doi: 10.1001/amajethics.2019.470.