Bioethics Blogs

The Sky is Falling: How Much Do We Owe A Patient?

by Craig Klugman, Ph.D.

Imagine if a patient went sky diving without a parachute and survived. You fixed up her body and explained to her the dangers of her activities. You refer her to a program that offers free parachutes and trains people on how to use them. Upon discharge, she does the same thing again and ends up back in your hospital? Do you perform the same surgeris again? What if she does this 3 times? Four times? Is there a point at which we “give up” on patients when they consistently return for the same problem from the same cause after ignoring all advice?

An article published in the Tampa Tribune raises just this dilemma. The reporter explains how heroin users who use dirty needles can acquire endocarditis that compromises their heart valves. The “fix” is a valve replacement that requires an 8-week hospital stay and costs about $500,000. The rub is that once they are healthy, many addicts leave, shoot up, and often are re-infected. Now doctors are saying “no” to working on these patients who come back more than once, sometimes twice.

In 2014, 447 people died in Florida with heroin in their bodies. This is a large increase from the 199 deaths in 2013. This trend is not just limited to the Sunshine State, nationally the number of deaths from heroin has increased 689% from 2001 to 2014 with a 28% increase from 2013 to 2014 alone. While these statistics are increases in deaths, the heart valve patients represent an increase in morbidity from heroin use—damage to one’s health.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.