‘Doing it To Themselves’: Can The Difficult Case of Repeated Foreign Body Ingestion Provide Us Ethical Considerations for Repeated Self Harm?
Saturday, October 14, 2023
9:00 AM – 10:15 AM ET
Location: Dover C (Third Floor)
Clinicians have a duty to care for patients whose injuries or illness may appear self-inflicted. However, in some cases, the self-inflicted element of these injuries raises additional ethical dilemmas, including issues of allocation of scarce resources, how to justly care for patients in the context that led them to self-injury, so-called ‘care contracts’ with patients, and whether it is ever appropriate to violate a patient’s autonomy to protect them from further self harm (either during acute recovery or long-term).
We examine these issues via a clinical ethics case study of rare but very complex situation: a patient representing an extreme case of Repeated Foreign Body Ingestion (RFBI). RFBI occurs among a relatively small number of patients, but occurs frequently for those affected, and often requires emergency surgery to resolved. This process is resource-intensive and may delay care for other patients with acute surgical needs, especially if ingestion is repeated regularly, as in some cases patients ingest objects again during immediate surgical recovery. Determining how to care for these patients, identifying the ways to best support a patient’s autonomy, determining how to ethically respond to the significant impact this has on care for other patients, and identifying ways to reduce the risk to these individuals is critical to responding to RFBI. We offer an analysis and synthesis of the existing literature on RFBI and extend these principles to what they can teach us about patients who frequently seriously harm themselves in ways that require significant resources to acutely manage.
Kayla Tabari House – Providence Center for Health Care Ethics – Providence Health and Services; L. Mclean House – Anesthesiology – Oregon Anesthesiology Group