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 2src19 book, Who Says You’re Dead? Medical & Ethical Dilemmas for the Curious & Concerned.
Several strong epidemiological studies have demonstrated that regions of the world where the element lithium occurs naturally in the drinking water have lower suicide rates. (The current proposed theory is that lithium is a protective factor in brain development, so it may take decades for the benefits of such lithium exposure to pay off in suicide prevention.) No known negative side effects have been associated with trace lithium exposure, but few long-term studies have been conducted to detect such risks.
The epidemiological studies on lithium have drawn the attention of Otis, the mayor of a small English city that has one of the highest suicide rates in the Western world. Otis proposes adding trace amounts of lithium to the drinking water in his community to see if this intervention will help. He believes this might, in the long run, prevent up to 5src unnecessary deaths each year. “If you don’t want to be exposed to lithium,” says Otis, “you can always buy bottled water.”
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: