Ethical Obligation of Surgeons to Noncompliant Patients: Can a Surgeon Refuse to Operate on an Intravenous Drug-Abusing Patient With Recurrent Aortic Valve Prosthesis Infection?

DiMaio, J. Michael; Salerno, Tomás A.; Bernstein, R.W.; Araújo, K. S. S.; Ricci, Marco; Sade, Robert M.

doi:10.1016/j.athoracsur.2009.03.088

Cited by 40 publications

(23 citation statements)

References 15 publications

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“…6,7,[13][14][15] Enthusiasm for operative management of IE in IVDUs in the surgical community is mixed, given anecdotal experience of repeated recurrences attributable to continued use of IV drugs. 16 Furthermore, independent of reinfection, survival of IVDUs is threatened by competing causes of mortality, including drug intoxication, trauma, and suicide. 8,[17][18][19] These issues raise questions about the utility versus futility of aggressive, resource-intensive surgical procedures, particularly among patients who are actively injecting drugs.…”

mentioning

confidence: 99%

Surgical outcomes of infective endocarditis among intravenous drug users

Kim

Ejiofor

Yammine

et al. 2016

The Journal of Thoracic and Cardiovascular Surgery

126

136

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mentioning

confidence: 99%

Surgical outcomes of infective endocarditis among intravenous drug users

Kim

Ejiofor

Yammine

et al. 2016

The Journal of Thoracic and Cardiovascular Surgery

126

136

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“…Although hospital and long-term survival did not significantly differ between two groups, the rate of recurrence of infection was higher in drug users. In the setting of high risk of surgical treatment for reinfection, a dilemma exists regarding the surgical indication for patients who are non-compliant to medical treatment, and develop reinfection due to relapsing of drug use [44]. There is a controversy as how many chances surgeons should give to non-compliant patients.…”

Section: Study Year Number Of Pts Hospital Findingsmentioning

confidence: 99%

Surgical Treatment for Tricuspid Valve Infective Endocarditis

Murashita¹

2018

Advanced Concepts in Endocarditis

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Isolated tricuspid valve infective endocarditis is relatively rare. However, the frequency of tricuspid valve infective endocarditis in the United States is rapidly increasing, mainly due to the epidemic of intravenous drug use. A medical treatment is the first choice for this disease; however, surgical intervention is required when the patients suffer from heart failure, large vegetation, or persistent bacteremia despite appropriate medical treatment. Several techniques for tricuspid valve reconstruction have been proposed, and their outcomes have been reported to be good. However, in the cases of severe valve destruction, tricuspid valve replacement is required. Post-surgical management of drug-induced infective endocarditis is challenging due to its poor compliance to medication and high rate of reinfection. There is an ethical controversy as to surgical indication for reinfection induced by relapse of drug use. In addition, because reoperation for tricuspid valve carries high risk, there is also a controversy regarding valve choice in drug users.

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“…After operation for a first episode, a referral should be made to a rehabilitation team. There should be an understanding within the department of the principles for treating a second episode of IE in an individual who continues intravenous injections despite involvement in a rehabilitation programme 34. This is a difficult area of practice which requires an individualised approach based on discussions within the IE team, with the patient and family, and with case-workers and hospital ethics teams if these exist.…”

Section: Policies and Guidelinesmentioning

confidence: 99%