Preventing Self-Harm From Repeat Foreign-Body Ingestion.

Document Type

Article

Publication Date

1-2020

Identifier

DOI: 10.1542/peds.2019-1515

Abstract

Mental health disorders in adolescents present some of the most challenging of all ethical dilemmas. This is particularly true when they lead to self-injurious behavior that can only be prevented by either limiting the freedom of the adolescent or forcing treatments on them that they do not want. Intentional and repeated foreign-body ingestion (FBI) in youth is a poorly understood self-injurious behavior that can be life-threatening. It poses unique clinical and ethical challenges. Ingestion of sharp or magnetic objects increases the need for endoscopic retrieval or surgical intervention with associated risks, including perforation and anesthesia-related adverse events. When behavior modification efforts fail to prevent recurrent FBI, the cumulative risk of medical intervention mounts. Sometimes, as a last resort, doctors consider surgical procedures that limit jaw movement and may physically prevent recurrent FBI. In this Ethics Rounds article, we present a case in which doctors consider whether it is in the best interest of a teenager with this behavior to undergo orthodontic jaw wiring as a next step in treatment of repeated FBI. Doctor commentary on the ethical decision-making process is provided.

Journal Title

Pediatrics

Volume

145

Issue

1

MeSH Keywords

Adolescent; Bioethical Issues; Foreign Bodies; Gastroenterology; Humans; Male; Orthodontic Wires; Orthodontics; Personal Autonomy; Recurrence; Secondary Prevention; Self-Injurious Behavior

Keywords

Adolescent; Bioethical Issues; Foreign Bodies; Gastroenterology; Humans; Male; Orthodontic Wires; Orthodontics; Personal Autonomy; Recurrence; Secondary Prevention; Self-Injurious Behavior

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