End-of-life decisions can often be some of the hardest decisions a person will ever have to make. They are quite literally making decisions involving life and death. For many people, this is the first time they have ever been involved in these types of situations or conversations.

It can be overwhelming and extremely challenging. People do not want to feel like they are giving up on someone or not doing everything they can to give their loved one a chance. But they also understand the realities of modern healthcare and the burden that some medical procedures and interventions can be. This can lead to a lot of self-reflection, questioning, and second-guessing. Did we do enough? Did we give up too early? Did we draw things out too long and only prolong the suffering?

As medicine continues to advance, more and more interventions and technologies will become available, allowing us to do even more and making these questions even more difficult. ECMO is a perfect example, and I remember an extremely difficult situation involving it.

Critically Ill Mom After Birth

The patient was in her early 40s and had just given birth to her third or fourth child. She had a challenging pregnancy and delivered the baby early, around 30 or 32 weeks, due to her water rupturing early. The patient then had further complications and became nonresponsive, requiring the team to perform an emergency C-section. The procedure was successful and her baby was born, but the mother was critically ill and had to be transferred to the ICU and started on very aggressive interventions. The situation then fell on her husband, who now had a family at home, a wife in the ICU, and a newborn in the NICU. Needless to say, he was overwhelmed and needed support from everyone.

The mother continued to decline to the point that her only chance of survival was to be transferred to another hospital to start ECMO, since the hospital she was in did not have access to ECMO. The husband said that she had long indicated she would not want overly aggressive measures like that and certainly would not want to be transferred away from her newborn daughter, but that she would also take any chance she could to live for her family. He was very conflicted about what the right thing to do was.

Individual Choice

Modern medicine is incredible—there is no denying that. People who once would have died can now survive, recover, and improve because of medical advancements. But sometimes that incredible nature comes at a cost—an expense that may be too high for some.

Ultimately, it comes down to the individual. What may be right for one patient could be completely wrong for another. And as medicine continues to advance and offer new breakthroughs, new ethical questions will arise alongside them.