The Ethical, Legal and Practical Implications of Providers’ Refusing Cardiothoracic Surgery to Patients with Opioid Use Disorders

Abstract: Persons with Opioid Use Disorders (PWOUD) are held to a different standard for cardiothoracic surgery than other patients with similar cardiovascular health conditions. The cardiothoracic surgery literature shows that PWOUD have better surgical outcomes than other patients because they have fewer co-morbidities and tend to be younger in age. However, PWOUD are often required to prove their abstinence in order to access cardiovascular surgery when other patients are not.
An ethics consultant and a nurse practitioner specializing in addiction medicine who work together at a large urban hospital will explore the ethical, legal and practical implications of refusing cardiothoracic surgery to PWOUD. Multiple case studies of PWOUD who were denied cardiothoracic surgery will be presented and discussed with the audience. The presenters will examine how patients are required to show “a commitment to abstinence” before surgery commences, yet providers do not define abstinence or create a timeline, nor is a pathway for sobriety enacted with the patient. Additionally, medical management is provided but may not be the standard of care given the severity of the patient’s case. The bioethical principle of justice is undermined when PWOUD are refused access to needed medical care and held to higher standards than the general public. The presenters will argue that stigma around PWOUD, lack of knowledge of addiction science, and unfamiliarity with pharmacotherapy too often inform the treatment plan. Lastly, the presenters will consider if the providers’ refusal to provide surgery runs counter to the Americans with Disabilities Act.

Keywords: Opioid Use Disorder (OUD), Provider refusal, stigma toward patients with substance use disorder