Infective Endocarditis Case Study

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The Dilemma of Devising a Policy for “Redo” Valvuloplasties in Recurrent Bacterial Endocarditis in Relapsing Intravenous Drug Users There has been an increasing incidence of intravenous (IV) heroin usage and overdoses in Ohio over the past 15 years. With it, hospitals in the state are seeing a substantial influx of medical complications related to IV heroin abuse. Infective endocarditis (IE) is one of the most severe, potentially life-threatening, complications for IV drug abuse with an inpatient mortality of 15-20% and a 1-year mortality of approximately 40%.1Once the bacteria infect the blood, they can adhere to cardiac structures creating infectious erosive masses which can lead to valvular insufficiency, stroke-causing
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While some cardiac surgeons or cardiologists feel it is not their role to decide whether or not they should operate on these patients. Most would not argue that clinicians should be good stewards of medical care and to not utilize valued resources when they would likely not result in much benefit. Indeed, health care is a limited resource and someone ultimately has to fund it. Inappropriate procedures or those that are likely futile not only lead to worse patient outcomes, but also to rising cost, can eventually limit access to …show more content…
This, in contrast, is more of a consequentialist approach and in line with more of a utilitarian ethical framework. In the case of recurrent IE in IV drug abusers, there can be a variety of ways in which the outcomes of recurrent surgeries may be futile: it may not be cost effective (i.e., risk of even more surgeries and recurrent IV drug abuse and skilled nursing care); it may not actually prolong life or even improve the quality of life (in the case of very high risk surgeries or in those with severely inhibiting embolic strokes); or it may even conflict with the internal social norms of the surgeon regarding illicit drug use. These clinical situations can be challenging because they demand a philosophical transition from the preservation of patient autonomy and treating them as ends in of themselves, which is in line with Kantian ethics, to the consideration of futility, more of utilitarian approach, when making the appropriate therapeutic decision. In these circumstances, physicians often collaborate with patients and their families in order to formulate a treatment plan while considering the physician’s clinical expertise and the patients’ wishes. However, in the cases of psychosocial futility like dealing with recurrent IE in IV drug abusers; these dialogues can be fraught with blame and mutual mistrust. This, in know way, means that physicians

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