Preventing Self-Harm From Repeat Foreign-Body Ingestion

Pediatrics. 2020 Jan;145(1):e20191515. doi: 10.1542/peds.2019-1515. Epub 2019 Dec 12.


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.

Publication types

  • Case Reports

MeSH terms

  • Adolescent
  • Bioethical Issues
  • Foreign Bodies / complications
  • Foreign Bodies / diagnostic imaging
  • Foreign Bodies / prevention & control*
  • Gastroenterology / ethics
  • Humans
  • Male
  • Orthodontic Wires / ethics*
  • Orthodontics / ethics*
  • Personal Autonomy
  • Recurrence
  • Secondary Prevention / ethics
  • Secondary Prevention / methods
  • Self-Injurious Behavior / prevention & control*
  • Self-Injurious Behavior / psychology