The dilemma of treating patients, based on their contributions to society

During my third-year internal medicine rotation, I was introduced to and helped care for a patient named Casey (name changed to protect privacy). I identified with Casey because we were the same age, and I felt empathetic toward her situation. Casey was very sick, a direct result of her risky behavior. She was admitted for infective endocarditis secondary to intravenous opioid abuse. She had her second heart valve replacement eight days prior with the first replacement done nine months before. The valve replacement was done at another area hospital, and she was discharged to a skilled nursing facility for extended antibiotics. Evidently, she left the facility and later presented at our emergency department. Her blood cultures grew multidrug resistant bacteria and fungus, presumably due to injecting opiates through her peripherally inserted cutaneous (PIC) line. The catheter that was placed as her lifeline was instead functioning an entry point for her addiction to inflict mayhem in her body. One week into her stay she was transferred to the critical care unit to manage a pericardial effusion turned cardiac tamponade, hypoxic encephalopathy, anuria and septic shock. The critical care team did not expect her to survive. Responses to this story will likely revolve around several ethical considerations, including autonomy, beneficence, justice and risk to others. Respecting Casey’s autonomy means that she will be provided with all opportunity for treatment because that is what ...
Source: Kevin, M.D. - Medical Weblog - Category: Journals (General) Authors: Tags: Physician Hospital Source Type: blogs