I´m not sure I see the ethics dilemma.
He gets the new heart valve and is offered drug-rehab. If he wants the heart valve, that is.
What does the Canadian medical system have to do with the problem anyway? If the tax-payers pay for medical treatment, then ALL citizens have the right to treatment. If it´s privately paid or by insurance, then ALL citizens whose paperwork is in order get the valve (correct me on this last one, those of you who live the US).
Is the ethics dilemma wether or not to give him the valve? How is that your dilemma as a doctor? The politicians (or maybe the hospital administrators) have made the rules. It´s THEIR dilemma. It´s YOUR operation. That´s how I see it anyway.
I see a parallel to my experience as a doctor in Denmark: A drunk comes into the hospital to receive treatment for his alcohol-abuse. He is admitted although the previous 20 times he has been admitted, he has left the morning after, without sticking around to talk to the “alcohol-unit” (as we call them). He is admitted because you cannot turn down a person in need - even though you know in your heart that what he really wants is just a warm bed to sleep in. Ethical dilemma? No, but annoying as h…