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 makes this care especially difficult. Repeated self-inflicted injuries raise 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). They also raise issues of frustration for caregivers seeing patients at medical risk that feels avoidable, and caregivers who feel that by providing immediate medical care they are likely not addressing the root of the problem for the patient.

We examine these issues via a clinical ethics case study of a patient representing a case of Repeated Foreign Body Ingestion (RFBI). RFBI occurs among a small number of patients, but occurs frequently for those affected, and often requires emergency surgery to resolve. In many cases, RFBI is extremely dangerous for patients who experience it, and caregivers find themselves haunted by wondering what they could have done differently for patients when the RFBI does repeat.