Doctors Refuse to Treat Obese – It's Nothing New – Just Like Smokers

Aug. 27, 2012 - PRLog -- A report that a Massachusetts physician is refusing to treat patients because they are obese has some so-called ethicists questioning the policy, even though the American Medical Association [AMA] says its completely ethical.

It's also far from unprecedented, it enjoys considerable support among physicians, and is modeled on similar policies regarding smokers, says public interest law professor John Banzhaf, who has been called a "Driving Force Behind the Lawsuits That Have Cost Tobacco Companies Billions," and a "Major Crusader Against Big Tobacco and Now Among Those Targeting the Food Industry.”

A 2012 report showed that a majority [54%] of doctors in the U.K. support measures to deny treatment to smokers and the obese, that smokers and obese patients are already being denied certain operations, and that more than a quarter of primary care [health] trusts [PCTs] have adopted treatment bans for those groups within the past year.  Indeed, even five years earlier, smokers were being denied operations unless they gave up cigarettes for at least four weeks, a policy authorized by the Health Secretary.  

In 2011, more than 10% of South Florida obstetrics-gynecology practices were refusing to treat otherwise-healthy women because they were too fat, turning down new patients who exceed obesity limits with weight cut-offs starting at 200 pounds – the same limit imposed by the Massachusetts physician.

In 2008, it was reported that 10% of U.K. hospitals were denying some surgeries to smokers, and that "a growing number of doctors apparently approve, arguing that patients have responsibilities as well as rights.  These include responsibilities to care for their own health."

This policy was supported by an article in the British Medical Journal arguing that smokers should be refused elective surgery unless they quit smoking for at least one month. A similar policy was also reportedly in place for the obese, who were required to lose weight before they underwent certain operations.

Banzhaf notes that a ban on surgery for smokers was in effect as early as 2001 in Australia.

Years earlier, several U.S. physicians argued in favor of denying certain operations to smokers, arguing in a published article that "it may even be in the public interest to deny renal transplantation to patients who do not make a serious attempt to quit smoking. The interests of both the individual and society may be best served by such an approach."

In most situations, smokers or the obese are denied certain treatments because their refusal to quit smoking or to lose weight makes the success of the operation problematical or, in the case of an OBGYN practice, makes giving birth more dangerous for both mother and child.  Doctors may well not wish to assume these added risks – and possible law suits and/or potential legal liability if things don't go well –  if patients are not willing to take steps to improve their own health.

"It may not be unreasonable, for example, for a surgeon to refuse to perform a liver transplant on someone who refuses to stop grossly abusing alcohol," he says.

In the Massachusetts situation, the doctor has reported that at least two members of her staff have already been injured because of obese patients.  "It may well be that the staff members are not big enough or strong enough to help prevent an obese patient from tripping, falling from a chair or bed, etc., especially if the patient has been weakened or become dizzy because of some kind of medical procedure.        

"In such a case, it may not be unreasonable – for the safety of her staff as well as the safety of the patient –  for a physician to require obese patients to seek treatment at a nearby medical facility which can both provide safer care and special treatment for the medical problem of obesity," suggests Banzhaf.

In addition to denying treatment in certain situations to smokers or the obese, another approach has been to charge them higher premiums for health insurance.  The additional revenue may be used not only to cover some of the added medical treatment they require, but also in the case of obese the cost of bigger and stronger gurneys, wheelchairs, etc. which may be necessary for safety.

Beginning in 2014, the Affordable Health Care Act authorizes charging smoking 50% more for their health insurance than nonsmokers, even if the employer does not have a wellness program in place.

JOHN F. BANZHAF III, B.S.E.E., J.D., Sc.D.
Professor of Public Interest Law
George Washington University Law School,
FAMRI Dr. William Cahan Distinguished Professor,
Fellow, World Technology Network,
Founder, Action on Smoking and Health (ASH)
2000 H Street, NW, Suite S402
Washington, DC 20052, USA
(202) 994-7229 // (703) 527-8418
http://banzhaf.net/ @profbanzhaf