Why Is Respecting Patient Autonomy So Hard?

A more intensely personal subject than body weight is hard to find. Add in the stigma of obesity and the subject becomes even more sensitive. So perhaps it should be no wonder that obesity presents some very hard challenges for respecting a person’s autonomy. The impulse to tell people what we might think is best for them plays out in public health policy and in matters of personal health.

But presuming to know what is best for a person or a population takes us into a briar patch of difficult issues. Especially in a subject as personal as obesity,  people have every right to make choices for themselves.

Personal Health and Healthcare

In most any situation, dispensing unsolicited advice about a person’s weight is simply rude. But it happens routinely. It leads people to avoid interactions that will subject them to rude and unhelpful advice. Unfortunately, that might include avoiding healthcare professionals.

Every person and every body is different. And the factors that contribute to obesity vary wildly from person to person. So approaches that work for one person often don’t work for another. In the range of evidence-based options for obesity care, you will find no magic cures. Finding a path to better health is usually a matter of trial and error.

Maximizing health and well-being without losing weight might be the best goal for one person. But another person might have very good reasons to find their way to a healthier weight. And the best way to meet those goals will be different for every person.

Unfortunately, many healthcare providers are more accustomed to thinking of patients in terms of responsibility and compliance. That mindset is not terribly helpful to people living with obesity.

Public Health Policies

Ethical controversies about public health policies to address obesity often revolve around issues of autonomy. Anne Barnhill and Katherine King suggest that policies to promote healthy eating must consider the moral value of respecting personal freedoms as well as health outcomes. These are not simple choices.

But one choice is simple. It’s the choice to respect people living with obesity. Health policy needs to reflect our voices and our lived experiences. Too often, we see this simple matter of respect neglected.

And that is a cruel, implicit bias.

Click here for more on approaches to patient autonomy in healthcare. For more on ethical issues in obesity prevention policies, click here and here.

Choices, photograph © Dheera Venkatraman / flickr

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October 8, 2017

2 Responses to “Why Is Respecting Patient Autonomy So Hard?”

  1. October 08, 2017 at 8:20 pm, Elizabeth K. Jones said:

    One of your five best posts, Ted. Thanks….

    • October 09, 2017 at 4:04 am, Ted said:

      Thanks, Elizabeth!