Does Drug User Deserve Second Heart Surgery? MD/JD Weighs In

Welcome to Ethics Consult -- an opportunity to discuss, debate (respectfully), and learn together. We select an ethical dilemma in patient care, you vote, and then we present an expert's judgment.

Last week, you voted on whether or not an IV drug user deserves a second heart surgery. Here are the results from more than 1,800 votes:

Do you operate to replace Mr. X's infected valve again?

Yes: 764

No: 1,090

Does the patient's age make a difference?

Yes: 525

No: 1,326

Does the willingness to join substance abuse rehab change your mind?

Yes: 850

No: 1,001

And now, Gregory Dolin, MD, JD, weighs in:

As a general matter, there is no legal obligation to treat anyone irrespective of the person's need or desire for treatment. Although the Emergency Medical Treatment and Active Labor Act (EMTALA) has created an exception to this baseline, the exception is limited and applies only to the extent that there is A) an emergency and B) treatment is sought in an emergency room of a hospital that participates in Medicare. Furthermore, even under EMTALA, an individual physician is not required to treat anyone. The hospital may require you to treat individuals as a condition of employment or of maintaining privileges, but that is a private matter between the doctor and hospital rather than a legal obligation.

Thus, as a legal matter, the choice to operate or not to operate is entirely within the doctor's purview. However, the doctor may be held liable for failing to explain the proper treatment to the patient (even if the doctor himself declines to undertake such a treatment). The purpose of this requirement is to enable the patient to seek an alternative provider who may be willing to treat him.

Finally, as a matter of medical ethics, there are justifications for either approach, which is probably why the vote breakdown is fairly even.

Gregory Dolin, MD, JD, is associate professor of law and co-director, Center for Medicine and Law at the University of Baltimore, where he also studies biopharmaceutical patent law. His work includes a number of scholarly articles, presentations, amicus briefs, and congressional testimony.

And check out some of our past Ethics Consult cases: 'Freeze' Little Girl in 6-Year-Old Body?, Deaf Couple Only Wants Deaf Baby, and Critical Patient With DNR Tattoo.

last updated 11.22.2019