In the eating disorder unit

To play a bit of devil's advocate here:

At what point does a socialised health service with limited resources, stop providing care for "self-inflicted" injuries?

In a busy hospital, the doctors have to triage and make priority decisions over where to apply resources and who to treat first.

Much like an alcoholic would never be at the top of a liver transplant list, at what point would an anorexic - who in this case had already been through over 30 mental health sessions - start to be denied care? At what point is it more ethical to spend those resources treating someone else, who might actually respond to treatment?

Again, just playing devil's advocate here. My personal opinion is that the NHS is critically underfunded at the moment and that should be fixed first. But I thought it worth pointing out the ethical debate over treating self-inflicted injuries in a socialised healthcare system is quite tricky. Especially considering that almost all mental health issues can fall under "self-inflicted" if you want to be callous.

I recognize the devil's advocacy and will refrain from judgement on your position. In response, there are a few options (probably more that aren't occurring right now; it has been many years since I was researching this in university):

- A "need-blindness" system a la financial aid at US universities, as well as those in a few other countries. This gives deniability as its primary benefit, when people ask "why was the person with a 'self-inflicted' (replace those single quotes with very sarcastic finger wags, please) need above me?" That deniability is imperfect, and causes political problems.

- A formalized ranking of factors that influence priority for care, performed by formulae as public and precise as possible. This could potentially include 'self-inflicted' conditions as something exerting downward pressure. Much like sentencing guidelines, there will always be some subjective/human leeway in the application of those formulae that draws accusations, founded or not, of bias. Also, in libertarian political climates, this will draw accusations of governmental meddling in personal decisions.

- Pricing care at a level likely to ensure that only a number of patients proportional to available care-giving resources are admitted. This would require massive changes (mostly removals) to subsidies that exist for healthcare. This is unlikely to succeed politically, and from a humanitarian/ethical point of view is likely to be viewed extremely negatively (a view I share). It would have the advantage of making the "real" problem (lack of caregiving resources, including skills and general awareness) directly apparent, but only as a form of shock therapy.

Those are ways to address your question directly and narrowly. Secondary solutions/those with knock-on effects (preventative care etc.) are out of scope of this answer.

EDIT and as to the "when is it ethical" portion of your question (the above answers are logistical, not ethical), it's a crapshoot. It boils down to the ethical questions of the trolley problem plus the determinism problem, neither of which are generally considered to be tractable alone, much less together.

I think the analogy is a bit flawed.

The whole reason they are there is the mental health issue, so denying them because it's not fixed is more like denying a person with cancer any more treatments because they haven't responded well to the first 30 treatments.

A mental health problem is no more "self inflicted" than cancer is.

It doesn't really change your ultimate question though.

Thank you for the reply, I was a little worried that people would think the question too unpleasant and just downvote to oblivion!

I was trying to think of explanations for the apparent callous nature of the emergency doctor who tried to discharge him from A&E and the nurses who gave equally brusk treatment. The first thing that came to mind was that they treated him effectively as a self-inflicted "slow" suicide case and it must be some ethical resource allocation issue. ie. hypothetically "Why am I treating this self-inflicted injury when there's a kid in the next ward who's been hit by a car and needs 24/7 monitoring"

Perhaps it has more to do with us (i.e. humans) not having a deep understanding of mental health treatment? I mean, we really don't understand the mind very well at all.

It's not just a clinical understanding either. We culturally approach mental health differently than other health. Get cancer and everybody rushes to your aid. Have anorexia and people ask questions about why we should pay for "self-inflicted" injuries (devil's advocacy couched, but still the question is posed).

Thankfully the cultural stance is changing. It wasn't long ago that the question about "self-inflicted" injuries wouldn't have even had to be couched in devil's advocacy.