Ethics consultation: cutting health insurance for risky activities?


Welcome to Ethics Consult – an opportunity to discuss, (respectfully) debate and learn together. We select an ethical dilemma from a real, but anonymized case of patient care. 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 step in with an ethical framework to help you learn and prepare.

The following case is adapted from the 2019 Appeal Book, Who said you’re dead? Medical and ethical dilemmas for the curious and the worried.

The US government is concerned about the health care costs of people engaged in purely voluntary high-risk behaviors such as motorcycling, hang gliding, and bungee jumping. Although injuries from such activities are not that common, they often prove to be very costly.

“Senator Cheapside” has proposed legislation to prevent all government-run insurance programs, including Medicare and Medicaid, from paying health care costs directly resulting from these activities. It identified 92 other activities not to be covered as well, ranging from hobbyist beekeeping to illegal drag racing. “If you want to be insured for injuries you pick up during high-risk activities,” he says, “you need to purchase private insurance to cover your costs.”

Jacob M. Appel, MD, JD, is director of psychiatric ethics education 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 an MS in Bioethics from Albany Medical College.

Check out some of our previous ethical consultation cases:

Stop Life Support for tax relief?

Prescribing off-label pills for optimal pilot performance?

Exhibition of forced weighings for hospital workers?


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