American heart surgeons are facing a difficult decision with respect to heart valve transplants for heroin addicts: whether to continually replace addicts’ heart valves or refuse to operate. The cost of a heart valve transplant, including six to eight weeks in the hospital, can be over $500,000. Although recipients of heart valve transplants are asked to abstain from drug use after the procedure, most heroin addicts fail to comply, meaning that the procedure will have to be repeated in the future. As a result, surgeons must decide whether performing a heart valve transplant for a heroin addict is a reasonable use of health care resources, especially considering that most heroin addicts do not carry health insurance.
Clinical ethicists opine that surgeons are not obligated to perform repeat operations on heroine addicts who fail to comply with treatment restrictions. Such ethicists argue that heroine addicts have a responsibility to change their behavior and when they fail to do so, surgeons have no duty to perform repeat procedures that would otherwise be unnecessary. However, according to substance abuse counselors, abstaining from heroine once addicted can be extremely difficult and many addicts continue their drug use to avoid withdrawal symptoms and maintain a sense of equilibrium, not to simply “get high.” Unfortunately, heroine use is on the rise and, at least for the foreseeable future, cardiac surgeons will continue to face this ethical dilemma.