Question

 

Katie Smith is a 29 yr. old female, mother of two children, with a history of IV drug use. She lives in a small town in Southeast Alaska. She’s recently travelled to Anchorage for medical care after experiencing extreme exhaustion and flu-like symptoms. Her medical team here has diagnosed her with endocarditis, a kind of infection of the heart, meaning that she will need heart valve replacement surgery. Unfortunately, this would be her second valve replacement in two years, and in addition, she currently tests positive for heroin and trace amounts of opioid pharmaceuticals. Her medical team is furious. Endocarditis is a direct result of her heroin use. After her first valve replacement, her medical warned her that a return to drugs could easily kill her and that they would likely be unwilling to do another valve replacement if her drug use continued. They recommended addiction services in Anchorage to her at the time.

Now, her medical team argues that they will not perform her heart valve replacement surgery. Doing so, they believe, would be providing futile treatment and an unethical use of resources.

In answering the questions below, you may consult an essay from the Seattle Times on this kind of case: “Facing Addicts with Ruined Hearts, Many Doctors Confront Tough Ethical Questions”, from April 2018. This is a shorter version of a longer New York Times article. I will post a link to the article on Blackboard with this test.

1. Given Wicclair’s categories of futility, why do you think Katie’s medical team considers the 2^nd valve replacement futile? Please explain in detail.

 

2. Do you agree with the medical team that the valve surgery is futile in some sense in her case? Why or why not?

 

3. What are two other ethical issues from class that could be most helpful in analyzing the ethics of this case? State and explain each issue in detail, and in your answer, be sure to show how the issues you raise apply to Katie’s case specifically. Please use separate paragraphs for each issue.

Answer 1

Endocarditis is an infection of the endocardium, which is the inner lining of your heart chambers and heart valves. Endocarditisgenerally occurs when bacteria, fungi or other germs from another part of your body, such as your mouth, spread through your bloodstream and attach to damaged areas in your heart.People with damaged or artificial heart valves or other heart conditions are most at risk.

Medical futility refers to interventions that are unlikely to produce any significant benefit for the patient.The goal of medicine is to help the sick. Physicians have no obligation to offer treatments that do not benefit patients. Futile interventions may increase a patient's pain and discomfort in the final days and weeks of life; give patients and family false hope; delay palliative and comfort care; and expend finite medical resources. Physicians who care for critically ill opioid users frequently face legal and ethical questions related to the provision of life-saving medical care. A key question that arises for physicians caring for critically ill patients with severe opioid use disorders is whether the patient’s condition is such that providing additional care has close to zero probability of being effective.Katie's medical team considers the 2nd valve replacement futile because of the drug dependancy and complications of the surgery,although katie was warned by th team post first surgery about the substance abuse complications they decided herr not a surgical candidate due to recidivism.

The 2nd valve surgery is futile in Katie's case. Neurobiology of addiction is best understood as a chronic disease of the brain, with changes in brain structure and function.Long term drug use leads to re-wiring of normal brain circuitry that can lead to persistent cravings. Tolerance quickly develops, requiring that more drug be administered to achieve the desired effect. Withdrawal symptoms that are quite dysphoric occur if the drug is not used after a period of time.

Ethical Issues:

Mrs.katie Smith has undergone valve replacement within the two year period.In the case of a person who uses injection drugs, behavior necessarily influences the expected outcome. If the new prosthetic valve is going to become re-infected due to continued drug use, and require another surgery, one might consider the first procedure to be futile.

UHCDA suggested allowing providers to decline to provide care that would be “medically ineffective,” and care that is “contrary to applicable health-care standards.It defined “medically ineffective” as treatment that would not provide the patient “any significant benefit” but did not elaborate further on what that standard means. The act also said physicians could decline to provide any type of treatment, as long as patients were properly informed of the decisions and associated medical risks.

Mrs.kathie life will be dangered if the surgery is carried out and there is no specific outcome of doing surgery.Ethically analyzing suggests conservative managements will be the suitable for her to survive.