Welcome to Ethics Consult — an opportunity to discuss, debate (respectfully), and learn together. We select an ethical dilemma from a true, but anonymized, patient care case. You vote on your decision in the case and, next week, we’ll reveal how you all made the call. Bioethicist Jacob M. Appel, MD, JD, will also weigh in with an ethical framework to help you learn and prepare.
The following case is adapted from Appel’s 2019 book, Who Says You’re Dead? Medical & Ethical Dilemmas for the Curious & Concerned.
The U.S. government is concerned about the healthcare costs of individuals engaged in purely volitional high-risk behaviors such as motorcycle riding, hang gliding, and bungee jumping. While injuries from such activities are not all that common, they often prove very costly.
“Senator Cheapside” has proposed legislation to prevent all government-run insurance programs, including Medicare and Medicaid, from paying for healthcare costs resulting directly from these activities. He has identified 92 other activities not to be covered as well — ranging from amateur beekeeping to illegal drag racing. “If you want to be insured for injuries you acquire while engaged in high-risk activities,” he says, “you should purchase private insurance to cover your costs.”
Jacob M. Appel, MD, JD, is director of ethics education in psychiatry and a member of the institutional review board at the Icahn School of Medicine at Mount Sinai in New York City. He holds an MD from Columbia University, a JD from Harvard Law School, and a bioethics MA from Albany Medical College.
Check out some of our past Ethics Consult cases: