“Meglio e La Piccola Certezza Che la Gran Bugia” (The Little Truth is Better than the Big Lie) – Leonardo da Vinci

I read the publication of Gansera et al, entitled “High-risk cardiac surgery in patients with intravenous (IV) drug abuse and/or active hepatitis C/HIV infection: an ethical discussion of 6 cases,”[1] as well as its accompanying commentaries with great interest. As a psychiatrist, neurologist, and psychotherapist, I would like to congratulate the editor on this new forum, which allows the reader to participate actively in the discussion and conclusion section.

One would like to see such an innovative platform implemented in other disciplines too; this “pioneering work” hopefully will give an impulse as a precursor for imitation in other renowned scientific journals.

After nearly 30 years of clinical experience, also with drug addicts, as a psychiatrist or psychotherapist, I would like to add some rather subject-specific remarks, preferentially concerning the psychological point of view, but not in terms of how to decide from the surgical perspective, as this is not my area of expertise. Superficially, there is no doubt about the necessity and obligation to perform an operation on each emergent patient without hesitation when technical feasibility is given. In my opinion, there is consensus within the original article and the invited commentaries on this responsibility.

As the title suggests, my remarks are divided into two parts.

• References

• 1 Gansera LS, Eszlari E, Deutsch O, Eichinger WB, Gansera B. High-risk cardiac surgery in patients with intravenous drug abuse and/or active hepatitis C or HIV infection: an ethical discussion of six cases. Thorac Cardiovasc Surg 2015; doi: 10.1055/s-0035-1549162
• 2 Wurmser L. The Hidden Dimension: Psychodynamics of Compulsive Drug Use. New York/London: Jason Aronson; 1977
• 3 Jahrbuch Sucht. Deutsche Hauptstelle für Suchtfragen E.V. Lengerich. Germany: Pabst Science Publishers; 2015