Our treatment of patients with severe obesity is unethical – but why?

Our treatment of patients with severe obesity is unethical – but why?

Bariatric surgery is life-saving and cost-effective but due to pervasive bias, obese patients are not a healthcare priority

Hilary Craig , Francis Finucane

The Irish Times.  Mon, July 9, 2018

In a field rife with controversy and disagreement, there is strong consensus among obesity experts at home and abroad that bariatric surgery is life-saving, cost-effective and reduces pain and suffering for patients with severe and complicated obesity.

More people than ever need surgery.

Data from the Irish longitudinal study of ageing (TILDA) suggest that 8 per cent of Irish adults over 50 years’ old, or 92,573 people, fulfil current surgical criteria. Although only some will pursue that option, their access to it in Ireland is dreadful, with fewer than one per 100,000 operations done here annually, compared to 70 per 100,000 in Sweden and France, and 50 per 100,000 in the US.

Delayed surgery causes harm, with one study showing a three-fold increased mortality over a decade compared to timely care. Although the Irish Government has recognised obesity as a disease since 2005 and has committed to developing bariatric services as part of its recent Obesity Policy and Action Plan, programmatic funding is still completely lacking and inadequate bariatric resources continue to frustrate health professionals and distress patients. A recent collaboration between UCD, NUIG and St James’s Hospital explored how this constitutes a violation of the four principles of contemporary biomedical ethics.

The first principle, autonomy, refers to an individual’s right to self-determination and their ability to make decisions about treatment based on their own beliefs and values. Autonomy requires intentionality, understanding and an absence of undue influence or coercion. Constraining treatment choice for patients breaches their autonomy. Although the archaic, pejorative view that obesity represents a lack of discipline and self-control has largely been dismissed, discourse about obesity remains derogatory and misogynistic. Doctors are as biased as the general public against people with obesity and 24 per cent of nurses in one US study described feeling “repulsed” by obese patients. Experiences of poor treatment can lead to distress and avoidance of care in affected patients. Half have weight bias internalisation, or self-stigmatisation, which is known to hinder weight-loss. Where stigma and bias limit access to proven, efficacious interventions, it constitutes an unacceptable breach of patients’ autonomy.

Read full Irish Times article here