Decision making in surgery: honoring patient autonomy despite high mortality risk in a 36-year-old woman with endocarditis

Infective endocarditis (IE) is a common complication in patients who inject drugs. We present the case of a 36-year-old woman with IE affecting both the aortic and tricuspid valves, along with a cardiac implantable electronic device infection, 11 weeks after combined aortic valve replacement, tricuspid valve replacement, and pacemaker implantation. The patient declined the medically indicated cardiac surgery due to her recent taxing surgical and rehabilitation experiences. Clear preoperative communication was crucial to align the patient's goals with available treatment options. Decision making was achieved through multiple interdisciplinary discussions, fostering openness, and dialog. This case highlights the challenges of surgical decision making and provides a valuable example of a patient-centered approach to informed consent within a multidisciplinary team. Moreover, it demonstrates the successful integration of palliative care into surgical management.