Extracorporeal Membrane Oxygenation (ECMO) Therapy in Intensive Care Units (ICU) in South African State Hospitals: A Normative Study.

Susan Murphy, Ames Dhai



The use of Extracorporeal membrane oxygenation (ECMO) in Critical Care is gathering momentum internationally. There is interest in it being included within the offering of Critical Care services in South African State Hospitals.


Most discussions about ECMO's appropriateness in State hospitals have been focused on healthcare economics and cost: benefit. To date, the bioethical considerations of this topic have not been comprehensively addressed. This research aims to articulate some of the normative ethical considerations to be considered when making decisions about government funding of medical therapies in general and costly life-sustaining therapies, such as ECMO specifically, within a limited resource environment.


Using a standard normative/philosophical design and the application of the ethical theories of Responsive Communitarianism and Ubuntu (African Moral Theory), to interrogate whether it is morally justifiable for Intensive Care Units in South African State Hospitals to be implementing ECMO programmes, at present.


Both Responsive communitarianism and Ubuntu (African Moral theory) advocate that when considering expensive therapies that extend or save lives such as ECMO, it is essential to consider the collective effect of such therapies on the community large – both the benefits as well as burdens. Accordingly, considering the National Department of Health's current state, it is ethically unjustified for ECMO to be included in the current critical care service in State Hospitals at present.

Authors' affiliations

Susan Murphy, Chris Hani Baragwanath Academic Hospital

Ames Dhai, University of the Witwatersrand

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Cite this article

South African Journal of Bioethics and Law 2021;14(2):67-71. DOI:10.7196/SAJBL.2021.v14i2.00750

Article History

Date submitted: 2021-08-16
Date published: 2021-08-16

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