I have let Sims suffer and/or die on purpose several times. That's what compulsive behavior drives me to after a while.
The ones I've had most fun with (and frustration from) was when I caged up Caleb Vatore and put sinks all around him that he couldn't get to -to drink water excessively. Another was when I caged up Don Lothario on a beach. He completely neglected his needs in favor of doing fire dance around a bonfire. I put it out, caged him, and put all the things he needed in front of him, but out of reach.
I've also broken up many couples and had my played Sim live a life of infidelity, etc...