Treating Addiction as a Terminal Disease

This perspective explores the ethical and medical dilemmas in caring for patients with opioid use disorder (OUD) through the lens of a complex case. A young woman with severe addiction and septic endocarditis reaches a decision to decline surgery and pursue hospice care highlighting how societal failures, inadequate access to comprehensive addiction treatment, and chronic trauma can lead patients and families to perceive addiction as terminal. The article scrutinizes concepts like decisional capacity, surrogate authority, and the burden of living with mental illness, ultimately arguing that respecting patients’ autonomous decisions must be paired with better structural support. It laments a healthcare system that is ill-equipped to treat addiction as a disease and urges reforms that prioritize trauma-informed care, housing security, and integrated mental health services.

This perspective explores the ethical and medical dilemmas in caring for patients with opioid use disorder (OUD) through the lens of a complex case. A young woman with severe addiction and septic endocarditis reaches a decision to decline surgery and pursue hospice care highlighting how societal failures, inadequate access to comprehensive addiction treatment, and chronic trauma can lead patients and families to perceive addiction as terminal. The article scrutinizes concepts like decisional capacity, surrogate authority, and the burden of living with mental illness, ultimately arguing that respecting patients’ autonomous decisions must be paired with better structural support. It laments a healthcare system that is ill-equipped to treat addiction as a disease and urges reforms that prioritize trauma-informed care, housing security, and integrated mental health services.