Ms. Claudio is a 62-year-old female admitted after suffering a cardiac arrest. She has a long history of cardiac and respiratory complications and has been cared for by her husband, Frank. Since her admission, she has not been able to remain conscious and thus has not been able to participate in decision-making or express her goals. She recently completed an advance directive with Frank stating that she wished to “withhold any and all medical interventions that are not likely to improve my life.”

She is continuing to decline and will likely die if aggressive medical interventions are not done. Frank has approached the medical team about the possibility of starting her on ECMO in order to give her a chance. The medical team is concerned that once they start Ms. Claudio on ECMO, they may not be able to take her off, and they wonder whether that is a state or quality of life she would find acceptable. They recognize that ECMO is likely the only intervention that could prevent her imminent death, but they are worried about violating her advance directive regarding interventions that cannot “improve” her life.