Extracorporeal membrane oxygenation (ECMO) therapy in intensive care units (ICU) in South African state hospitals: a normative study

Abstract

Objective Most discussions about the appropriateness of Extracorporeal Membrane Oxygenation therapy (ECMO) in state hospitals have been focused around healthcare economics and cost:benefit. To date, the bioethical considerations of this topic have not been comprehensively addressed. This research articulates the normative ethical considerations which need to be considered when making decisions about government funding of medical therapies in general, and costly life-sustaining therapies, such as ECMO, specifically, in a resource limited environment.

Methodology This research report uses a normative/philosophical design to apply the ethical theories of Principlism, Responsive Comunitarianism and Ubuntu (African Moral Theory) to the question of whether it is ethically justified to embark on ECMO therapy programmes in South African State Hospitals. The report outlines the healthcare challenges currently facing South Africa, and the state hospitals in particular. Within the context described, this research report argues and defends the position that it is not morally justifiable for Intensive Care Units in South African State Hospitals to be implementing ECMO programmes. Finally, responses to the commonly provided reasons in favour of implementing ECMO programmes in South Africa are addressed and rebuttals to these arguments given.

Conclusions When applying the normative ethical theories of Principlism, Responsive Communitarianism, and Ubuntu (African Moral theory), it is not morally justifiable for South African State Hospitals to be implementing ECMO (Extracorporeal membrane oxygenation), given the current state of national healthcare services.