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OBES SURG (2011) 21:14691476 DOI 10.1007/s11695-011-0386-1
REVIEW
Ethical Issues of Obesity Surgerya Health Technology Assessment
Samuli I. Saarni & Heidi Anttila & Suoma E. Saarni &
Pertti Mustajoki & Vesa Koivukangas & Tuija S. Ikonen &
Antti Malmivaara
Published online: 10 April 2011# Springer Science+Business Media, LLC 2011
Abstract New surgical technologies may challenge societal values, and their adoption may lead to ethical challenges. Despite proven cost-effectiveness, obesity (bariatric) surgery and its public funding have been questioned on ethical arguments relating to, for example, the self-inflicted or non-disease nature of obesity. Our aim was to analyze the ethical issues relevant to bariatric surgery. A comprehensive health technology assessment was conducted on bariatric surgery for morbid obesity using the EUnetHTA method, including a fully integrated ethical analysis. The ethical arguments suggesting that obesity should not be surgically treated because it is self-inflicted were rejected. Medicalization of obesity may have
both positive and negative effects that impact the various stakeholders differently, thus being difficult to balance. Informing bariatric surgery patients and actively supporting their autonomy is exceptionally important, as the benefits and harms of both obesity and bariatric surgery are complex, and the outcome depends on how well the patient understands and adheres to the life-long changes in eating habits required. Justice considerations are important in organizing surgical treatment of obesity, as the obese are discriminated against in many ways and obesity is more common in socioeconomically disadvantaged populations who might have problems of access to treatments. Obesity should be treated like other diseases in health care, and
The study is based on a health technology assessment of surgical treatments for morbid obesity. The assessment was conducted by Finnish Office for Health Technology Assessment and published in Finnish as Ikonen et al. [9]. Full report is available at: http://www.thl.fi/thl-client/pdfs/739965e6-bf7f-4d48-9d29-31b2275c9976
Web End =http://www.thl. http://www.thl.fi/thl-client/pdfs/739965e6-bf7f-4d48-9d29-31b2275c9976
Web End =fi/thl-client/pdfs/739965e6-bf7f-4d48-9d29-31b2275c9976 .
S. I. Saarni (*) : S. E. SaarniDepartment of Mental Health and Substance Abuse Services, National Institute for Health and Welfare,P.O. Box 30, 00271 Helsinki, Finlande-mail: [email protected]
S. I. SaarniDepartment of Psychiatry, Helsinki University Central Hospital, University of Helsinki,Helsinki, Finland
H. AnttilaDepartment of Lifestyle and Participation, National Institute for Health and Welfare, Helsinki, Finland
S. E. SaarniCity of Helsinki Health Centre, Helsinki, Finland
V. KoivukangasDepartment of Surgery, Oulu University...