With innovations in medicine, ethicists are consulted on cases without sufficient clinical knowledge or ethical precedent to call upon. Under pressure from a distraught care team, the ethicist in this case tries to justify a unilateral withdrawal of an advanced form of cardiac life support – VA-ECMO. She shares how her sense of obligation to relieve the team’s moral distress blinded her from appreciating that the patient was not "really, most sincerely dead." In consultation with the hospital’s legal counsel, the ethicist agreed that the patient did not meet strict criteria under the definition of death by circulatory criteria/cardiac death.

The patient’s family, in shock by his rapid decline following a complicated aortic dissection repair, were holding out for a miracle. Because they could see the ECMO machine pumping blood throughout his body, they struggled to believe he would never recover. The ethicist used a different strategy to resolve the conflict: She coached the team to present the medical facts in lay-person’s terms, using a commonly recognized sign of cardiac death, the flat-line. The family then accepted that patient’s native organ was gone. Since he was not a candidate for transplant, they agreed to disconnect the ECMO machine.