Ethical issues in pediatric bariatric surgery
Section snippets
Beneficence
Beneficence obliges physicians to act for the good of the patient, seeking ways to heal, restore health, and promote well-being. For pediatric patients who are morbidly obese, the ethical principle of beneficence requires that physicians seek to reverse the physical and psychological derangements that interfere with well-being. If nonsurgical interventions, such as caloric restriction diets, exercise programs, and behavioral therapy, were effective in achieving substantial weight loss with
Nonmaleficence
In taking the Hippocratic Oath, physicians promise adherence to beneficence—“I will use treatment to help the sick according to my ability and judgment …”—and to the obligation of nonmaleficence—“… but I will never use it to injure or wrong them.”7 In considering surgical treatments for morbid obesity, the risks of harm during and after an operation, the likelihood of achieving the desired outcomes, and the potential for unanticipated complications underscore the obligation of nonmaleficence. In
Autonomy (informed consent)
In commenting about obesity intervention and ethics, Holm observed that “the purpose of ethical reflection is to help us decide how to act in the real world … it must take into account all aspects of a proposed course of action, it must rely on good factual evidence …”11 The principle of autonomy has assumed paramount stature in western bioethics, as progressive societies value individual choice and self-governing, especially as it relates to one's body. Autonomy in decision making for pediatric
Justice
The principle of justice (also a virtue) allows that each person receives a fair share of health resources and equitable treatment. Recently, significant disparities were found for adult patients who undergo bariatric surgery, with fewer African Americans, Hispanics, low-income individuals, and males having these operations in the USA than expected based on morbid obesity statistics in these groups.14 How does justice affect the ethics of pediatric bariatric surgery? The manner in which
Virtue ethics and pediatric bariatric surgery
Virtue ethics, with its roots in Greek philosophy, differs from principle-based ethics, which is concerned with the action that causes an ethical dilemma, by setting its focus on the moral agents and the recipients of these actions. In their classic text, The Virtues in Medical Practice, Pellegrino and Thomasma describe several virtues that impact the interactions of physicians with their patients, colleagues, the medical community, and society.16 Trustworthiness implies that patients can rely
Innovation and research in pediatric bariatric surgery
The impetus to conduct clinical research in surgery typically originates from a state of equipoise, in which there is a general lack of agreement among surgeons about the best treatment or operation for a given condition. Unfortunately, the surgical disciplines, and pediatric surgery in particular, have rarely instituted clinical trials for the explicit purpose of determining the optimal procedure for a given condition. Within pediatric surgery, the best examples of “scientifically sound”
References (21)
- et al.
Do obese children become obese adults?A review of the literature
Prev Med
(1993) - et al.
Predictors of attrition from a pediatric weight management program
J Pediatr
(2004) - et al.
Informed consent issues in the conduct of bariatric surgery
Surg Obes Relat Dis
(2008) - et al.
Is family-based behavioral weight control appropriate for severe pediatric obesity?
Int J Eat Disord
(2001) - et al.
Screening and interventions for obesity in adults: Summary of the evidence for the US Preventive Services Task Force
Ann Intern Med
(2003) Health consequences of obesity in youth: Childhood predictors of adult disease
Pediatrics
(1998)- et al.
Treatment of pediatric and adolescent obesity
J Am Med Assoc
(2003) The Foundations of Bioethics
(1986)Bioethical and legal implications of pediatric gastric bypass
Willamette Law Rev
(2004)- et al.
Bariatric surgery: A systematic review and meta-analysis
J Am Med Assoc
(2004)
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Development and application of an ethical framework for pediatric metabolic and bariatric surgery evaluation
2021, Surgery for Obesity and Related DiseasesThe role of ethics consultation in decision making for bariatric surgery in pediatrics
2020, Seminars in Pediatric SurgeryBariatric Surgery Needs a Seat at the Children's Table: Bridging the Perception and Reality of the Role of Bariatric Surgery in the Treatment of Obesity in Adolescents
2018, Clinical TherapeuticsCitation Excerpt :Caniano50 outlined several important issues facing adolescents, their families, and their health care practitioners with regard to their role in the decision-making process. Her discussion helps navigate specific challenges of this procedure in a young patient.50 The issues of informed consent and assent may be particularly sensitive in adolescent population, especially in cases of discordant points of view between patients and their parents.51
The Maturation of Research on Psychosocial Outcomes Among Adolescents Receiving Bariatric Surgery
2018, Journal of Adolescent HealthASMBS pediatric metabolic and bariatric surgery guidelines, 2018
2018, Surgery for Obesity and Related DiseasesAdolescent bariatric surgery: a systematic review of recommendation documents
2017, Surgery for Obesity and Related Diseases