Debate Will Explore How to Treat IV Drug Users with Recurrent Endocarditis

Robert M. Sade, MD

Robert M. Sade, MD

When a post-surgical reinfection in an endocarditis patient occurs as a result of drug use, does the drug user deserve a second valve replacement? Or is this a waste of surgical resources?

These are two questions that experts will address during the Ethics Debate on Sunday afternoon.

“What is best for recidivist addicts: requiring them to take responsibility for their own health and not reoperating if they continue using IV drugs or exposing them to a series of major reoperations that will not prevent their inevitable death by endocarditis?,” asked debate moderator Robert M. Sade, MD. He is director of the Institute of Human Values in Health Care at the Medical University of South Carolina in Charleston and chairs the Cardiothoracic Ethics Forum, a joint STS and American Association for Thoracic Surgery group that is responsible for ethics education in the specialty. 

The debate will center around a young woman who was treated with an opioid painkiller after a major operation and then, in a typical addictive pattern, becomes dependent on opioids and heroin. As a result, she develops infective endocarditis. A surgeon replaces her infected aortic valve and refers her to a drug rehabilitation center. After refusing rehab, the patient is readmitted within a few months with recurrent endocarditis. The surgeon faces the dilemma of whether to reoperate, given that the patient declined treatment for her drug addiction.

Ethics Debate: Should Opioid Addicts Have a Second Valve Replacement for Endocarditis?

12:45 p.m. – 1:45 p.m.
Room 211

The pro position might argue that surgeons have a responsibility to do the best for their patients; nothing is more important than continuing to live, even when their patients are suffering from the second disease of drug addiction, Dr. Sade said. 

The con position likely will be that surgeons have no obligation to use precious—and costly—surgical resources on patients who do not shoulder personal responsibility and make an effort to manage their drug addiction, he said.

“Surgeons are ethically committed to doing what is best for their patients, but also arguably have responsibilities for stewardship of surgical resources,” said Dr. Sade.

Infection of cardiac valves has been a growing problem due to the opioid crisis, and the burden on cardiothoracic surgery services has become quite heavy, Dr. Sade said. Reinfection is not uncommon, but occurs mostly in patients who revert to using drugs. 

“Though this debate will not produce definitive answers to difficult questions, it will provide the analytical tools needed for thinking about how to approach them,” he added.