One 'darwin fan' I picked up back when playing the paramedic game was a teenager who was working on his carburetor while smoking a cigarette -he asked his girlfriend to 'fire up the car' while he adjusted the carb, and lit himself on fire as well. He was flash-burned from the waist up (had jeans on and they protected his lower regions -but when we arived, he was sitting (smoking a cigarette) in front of his car, his skin was literally sloughing off of his chest and shoulders, third degree burns on chest, arms and face. He told us what happened (he had rebuilt the carb shirtless to avoid getting fuel on his shirt, but had fuel on hiself from scrubbing the carb before putting it back together and onto the car etc etc).
I've lost track of the ones who end up on our floor as quads who went out for a drive while drinking. One week we actually had TWO who had gotten inebriated, and were on drugs (coke for both of 'em) and they both fell off of their bicycles and broke their necks -a C-5 for one of 'em, 5 and 6 for the other- -aside from their age differences and the fact that they were from different races, they could have been twins) both quads. Your tax dollars at work! yeah baby!
Another self-inflicted stupidity -drinking and driving, unrestrained. This patient will let himself be cared for (dressing changes, meds, turn q2hr etc) for a while, and when he has started improving, will then refuse all care for a while. Has a crater in his sacral region I could put my arm inside of. Psych evals have ruled him competent. Those get depressing. I won't take care of that one anymore -its not worth the trouble and grief. This patient is very intelligent, and just does not want to leave the hospital.
Once gave a spouse and the patient grief for sneaking food into the room (for the patient) -uncontrolled diabetic eating pizza and ice cream. I said that if they wanted to commit suicide that was fine, but not in the hospital, and not when >I< have to take care of them. I really do feel bad for diabetics -its a situation that really sucks. But my job is to help you get better -with the goal being that you leave (preferably NOT "toes-up") -when someone gets better under my care, I feel pretty darn good about it because I know that I was partly responsible. The converse is true.