Leaders working in case management are under unforgiving time limits, pressures, and resource constraints that make decision-making difficult. The challenge relates to the way healthcare is moving and the speed with which change is occurring within organizations as they continue to change, form partnerships, and other issues.

Most patients learn about the the option of left ventricular assist devices when they are facing the possibility of death. Emotion is high, and biases of cognition are prevalent. These issues pose challenges to ethical decision-making and informed consent.

Ethicists are seeing increasing numbers of consults involving extracorporeal membrane oxygenation (ECMO), the most aggressive life-sustaining technology available. With ECMO, which is currently offered by about 250 U.S. hospitals, some patients are saved who would otherwise die.

Federal law requires hospitals to inform patients of the need to choose a surrogate. However, many institutions perform this task poorly, due in part to a lack of clear policies, proper training, and other support. There are a few ways the ethics team can help.