U.S. - Injecting Drugs Can Ruin a Heart. How Many Second Chances Should a User Get?

S.J.B.

S.J.B.

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Injecting Drugs Can Ruin a Heart. How Many Second Chances Should a User Get?
Abby Goodnough
The New York Times
April 28th, 2018

OAK RIDGE, Tenn. - Jerika Whitefield's memories of the infection that almost killed her are muddled, except for a few. Her young children peering at her in the hospital bed. Her stepfather wrapping her limp arms around the baby. Her whispered appeal to a skeptical nurse: "Please don't let me die. I promise, I won't ever do it again."

Ms. Whitefield, 28, had developed endocarditis, an infection of the heart valves caused by bacteria that entered her blood when she injected methamphetamine one morning in 2016. Doctors saved her life with open-heart surgery, but before operating, they gave her a jolting warning: If she continued shooting up and got reinfected, they would not operate again.

With meth resurgent and the opioid crisis showing no sign of abating, a growing number of people are getting endocarditis from injecting the drugs - sometimes repeatedly if they continue shooting up. Many are uninsured, and the care they need is expensive, intensive and often lasts months. All of this has doctors grappling with an ethically fraught question: Is a heart ever not worth fixing?

"We've literally had some continue using drugs while in the hospital," said Dr. Thomas Pollard, a veteran cardiothoracic surgeon in Knoxville, Tenn. "That's like trying to do a liver transplant on someone who's drinking a fifth of vodka on the stretcher."

The problem has consumed Dr. Pollard, a calm Texan who got his Tennessee medical license in 1996, just after the widely abused opioid painkiller OxyContin hit the market. He has seen an explosion of endocarditis cases, particularly among poor, young drug users whose hearts can usually be salvaged, but whose addiction goes unaddressed by a medical system that rarely takes responsibility for treating it.
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Read the full story here.

Read letters to the editor in reply to this story here.
 
Theres no such thing as too many second chances.

A friend of mine, his wife died of endocarditis. Leaving behind him and their 5 year old daughter. Just terrible. She may have been a junkie but her life was still valuable. In my opinion nobody has the right to just arbitrarily decide who's lives are worth saving and who's aren't.
 
Yeah talk about a fucked up articke. But it’s nothing new... drug policy is organized around killing drug users, particularly injection drug users.
 
Funny that someone would say this, but they wouldn't make the same suggestion not to continue life extending medical support for someone in their 80s in poor health or a terminal cancer patient. They WILL die. Soon. It can't be delayed for long. But an IVDU still has a chance of getting clean when they've had enough.

In other words the overall prospects of continued life are greater, the only difference of consequence is that one is perceived to be at fault and the other isn't. That's pretty bullshit too, but that perception makes a big difference and people, especially assholes are highly prone to wanting to find reasons to blame people.

We will even continue life saving medical procedures for someone whos 80 or with terminal cancer and who legitimately wants to die (DNRs don't cover all life extentijg medical treatment).
 
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No point billing people for money you won't get.

It's kinda the other way around, money is probably part of the whole motivation. You over charge the people you can get money out of, if you can't get the money back and moneys your focus, the best move is to get out of providing the service to start with.
 
There are definitely surgeons opting not to do a second valve replacement surgery due to endocarditis in continuing IV drug users. It's often a v subjective call.

Part of it's reimbursement, part of it a shortage of skilled surgeons, part of it is stigmatization of iv drug users, and part of it is that the second surgery is far more likely to be problematic than the first, which in turn lowers surgeons stats related to favorable outcomes and opens the door for litigation.

I've definitely sat through some ice cold meetings about hospital policy decisions, but on an institutional level, I don't think it's ever 100% about money.

I would actually attribute the one-treatment-per-IV drug user policies as mostly due to stigma by clinicians, limited human/other resources and costs likely to be absorbed by hospital/practice group, in that order.
 
Well, if doctors can refuse to give treatments on religious grounds in some states, then this isn't that much of a stretch.

The U.S. allows the righteous to commit immoral actions as part of "freedom". I'm glad I live in Canada. Our health care here has some major flaws but deciding that a patient has had enough second chances isn't one of them. I could fuck myself up 10 times and get treatment every time.
 
Foreigner said:
Well, if doctors can refuse to give treatments on religious grounds in some states, then this isn't that much of a stretch.

The U.S. allows the righteous to commit immoral actions as part of "freedom". I'm glad I live in Canada. Our health care here has some major flaws but deciding that a patient has had enough second chances isn't one of them. I could fuck myself up 10 times and get treatment every time.
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Are you talking about abortion or something else? Cause generally abortion isn't a life saving treatment, let alone emergency life saving. Even just from a totally pro choice perspective.

Now I don't wanna start an abortion debate or get too off topic here, personally I'm OK with doctors being allowed to refuse to act in non emergency situations for nonlife saving procedures they object to on moral grounds. If you're not, ok, I disagree but it's off topic so we can leave it there. Mainly I'm asking if abortion is really all you had in mind.
 
Just to add... if a miscarriage occurs in the third trimester, the procedure (which is absolutely necessary because of rotting foreign tissue attached to the formerly maternal blood supply) is considered a late-term abortion and coded as such.

Thanks to pro-life nuts, women have to endure stigma on top of their miscarriage. Unfortunately, the same doctors who do the rare late-term abortions are few and far between.
 
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cduggles said:
Just to add... if a miscarriage occurs in the third trimester, the procedure (which is absolutely necessary because of rotting foreign tissue attached to the formerly maternal blood supply) is considered a late-term abortion and coded as such.

Thanks to pro-life nuts, women have to endure stigma on top of their miscarriage. Unfortunately, the same doctors who do the rare late-term abortions are few and far between.
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I don't see that as relevant. All sorts of stupid people's come up with all sorts of bullshit ways to play with words and get excessively pedantic or extreme with terminology. In the end its just words though. Calling it a late term abortion doesn't mean it has any of the same meaning of what people properly use the term late term abortion for. Which is not something like that.

People can be assholes. That's just life. The point is even most of the most extreme pro lifers are OK with abortion if the alternative will likely result in the mothers death. That some people are too stupid to not just go "abortion = bad" with no interest in the meaning or subtleties shouldn't really mean anything.
 
For all you pro abortion people out there, taking out a fetus that's died is a bit different than taking out one that's alive, don't you think? :\

Can't wait to see what can ov worms that opens up.
 
^ Medically, it's actually not that different, except it's urgent to remove the dead rotting fetus and v dangerous for the mother.

And like any other surgery on the planet, you'd like a surgeon who is experienced with the exact procedure and sympathetic if possible.

So it's kind of a big deal when doctors (OBs) who actually know what they're doing have their lives threatened and get harassed by nut jobs so that service is hard to get.

Plus the patients sometimes have to deal with harassment themselves.

Ffs fight to overturn Roe v. Wade instead of harassing and even killing doctors and hassling patients.

And that's how the procedure is recorded so the patients get extra grief even finding a surgeon, much less a good one. And even if the coding was different, the procedure is the same medically, so it's the same problem. And good luck finding a great obstetric surgeon for that procedure on short notice after finding out your baby is dead.

And yes I agree it shouldn't mean anything, but the reality is different.

It's wrong.
 
You lost me at medically it's not different to remove a dead fetus vs a live one. I do however agree that harassment and violence isn't the way to advocate a pro-life stance. I think education is.
 
Man you know I have pro life leanings. But cduggles did say specifically that medically it's not that different. Which doesn't sound at all implausible. That's not a moral judgement.

Mechanically it's not that different to shoot someone in the face as opposed to shooting a phone book. Context is everything. Besides, I was under the impression this came out of the concept of abortion where the mothers life is in serious danger. Which is pretty much as uncontroversial as abortion gets.
 
Actually I'm wrong, this subject came up because of abortion where the mothers medically needs it and the fetus is dead anyway. At that point calling it abortion at all is dubious, which I believe is the entire point.

Complaining about "abortion" of a fetus that's never gonna make it no matter what you do is just taking what might have once been a reasonable moral belief and taking away all reasoning.
 
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