Should weight loss surgery be available to minors?By: Stephanie Snelson, Jennifer Butler, Angel Figard, Katherine Eastridge,

Group FiveCode of ethics

Statement of Intent:

To come together as a productive team with the goal of completing our project; using our fullest potential individually and as a whole

Values:

Dependability

Integrity

Team Work

Diligence

Open-Mindedness

Principle:

Each team member will strive to be dependable and diligent in completing our project. We will work together, respecting each other’s views and ideas while using open minds. Additionally, each person will consider the effects that their actions will have on the rest of the team.

Code of ethics (cont’d)

Guidelines/Rules: 1) We will work on our individual tasks and then as a

team we will finalize each step together (majority vote).

2) If anyone is not able to do their portion, the team must be notified promptly, so that we can get that portion completed.

3) If someone does not understand their portion, please ask for help, and do not depend on everyone else to get all the work done. Remember, we are also grading each other based on participation.

4) Please consider everyone on the team as this grade is for all of us; this is a GROUP project. 

The scenario

Ricky is a 16-year old boy, who is 5’9” and weighs 350 pounds. Rick was always a larger baby and child; but as he got older, he didn’t thin out like other kids, instead, he gained more and more weight. Now, he has an extremely hard time fitting in with his peers in high school even struggles with getting from one class to the other on time, being such a large campus.

 Ricky has been working with his pediatrician for the past 10 months, with various dieting techniques; also trying to find a work-out routine that Ricky would be capable of doing. Finally, with no signs of progress, his pediatrician recommended that he go to Cincinnati Children’s Hospital where they have the Lifelong Weight Management Center. There they will look at Ricky’s past efforts, why they aren’t working, and if there is any other option. Additionally, Ricky has been dealing with extreme Asthma, and just found out that he now has type-2 diabetes. Considering Ricky is only 16, his health’s outcome is not looking very good for his future.

After considering all options, and many counseling sessions, the Children’s Hospital has confirmed that Ricky is an ideal candidate for bariatric surgery (gastric bypass surgery). With him and his parents in agreement and having learned all that is needed to know, they proceed with the surgery; despite concerns from other family and friends.

The possible conflict of interest The biggest one would be the

issue of surgery allowing the child an easy way out of his problem and not making him work towards his goals. If you allow a child an easy way out of every situation he gets into then he will never work his way out of anything. Allowing the child to have the surgery some may view as the easy way and try and prove that it would be better for the child to work of the weight through diet and exercise.

Stake holders &Possible outcomes

Fallacies 1) Ricky cannot handle the

maturity of the decision to have weight loss surgery; he’s only 16.

2) Bariatric surgery is the only way to lose more than 100 pounds.

3) By not having the surgery, Ricky will be depressed for the rest of his life.

4) Caring parents would never make their child undergo a major surgery until they were an adult.

5) Some people are destined to be overweight, and not even surgery will change that.

Theories

Consequential / Act Utilitarianism

Always act in order to promote the most happiness for the greatest number of people.

Ricky (1 person)

Parents (2 people)

Doctors (2 people)

Net Utility

Ricky has the Surgery, and it is a success

+10 +7x2 = +14 +8x2 = +16 +40

Ricky tries to diet and exercise with no medical support; and doesn’t succeed

-7 +2x2 = +4 -3x2 = -6 -9

Ricky diets and exercises with support of his family & Dr’s; has limited success

+5 +5x2 = +10 +6x2 = +12 +27

Ricky does nothing at all; loses no weight and stays unhealthy

-10 -10x2 = -20 -7x2 = -14 -44

Outcome

Using this theory, and using the scenario’s outcome, Ricky having the surgery is the ethical option that would produce the greatest amount of happiness in the largest amount of people.

Non-Consequential / Natural Law

In every person, good and evil, there is the basic principle “Good is to be done and pursued, and evil avoided”; Using the following values as the standard: Human life, Health, Procreation, Caring for children and promoting their welfare, Knowledge and the avoidance of ignorance, Human relationships and the consideration of other people’s interests.

Outcome

Ricky has the surgery, and it is a success

Doesn’t go against any of the Universal Values

Ricky tries to diet and exercise with no medical support; and doesn’t succeed

Goes against the Health, and Welfare of children values

Ricky diets and exercises with support of his parents and Dr’s; has limited success

If Ricky doesn’t lose enough weight to get healthy, then it goes against Health and Welfare of children values

Ricky does nothing at all; loses no weight and stays unhealthy

Goes against Health, Welfare of Children and Human Relationships.

 Using this theory, and assuming each person shares these universal values, then Ricky having the surgery is the best ethical decision.

Options for surgeries

Laparoscopic Gastric Banding- A surgically implanted device used to help a person lose weight. In a surgical procedure, a band is placed around the upper part of the stomach, creating a small pouch that can hold only a small amount of food

Gastric Bypass- A surgical procedure by which all or part of the stomach is circumvented by anastomosis to the small intestine, performed to overcome obstruction or in the treatment of morbid obesity.

Pros and Cons with any weight loss procedure

Pros

Helps prevent, reduce, and/or reverse long term health risks – such as metabolic syndrome

Reduces risks of anxiety, depression, and isolation

Children and younger adults tend to recover much more quickly

Cons

Death

Infection

Difficulty coping with emotions

Laparoscopic Gastric Banding Pros

Healthy and steady rate of weight loss

Low risk of nutritional deficiencies

Reversible

Less hunger

Reduces risk for cardiovascular disease and diabetes

Improved self-esteem

Portion control

Because the stoma is adjustable, the amount of food intake can be adjusted to fit the dietary needs of the patient.

Less invasive approach, so patients recovery faster, and are more quickly

motivated to seek out exercise routines.

No stomach stapling, cutting, or intestinal rerouting.

Cons

Laparoscopic gastric banding has shown to have a much smaller death rate, about 1 in 1000 patients, but complications do still occur.

Lack of satisfaction with eating

The necessity of individuals to make healthy eating choice – not to be used as a quick fix

Unsatisfactory weight loss

Infections

Abnormal bleeding

Implanted device

There is a 10% reoperation rate for problems such as band slippage, band erosion, and port problems.

Gastric Bypass

Pros High degree of hunger fulfillment

High rate of success with both excess weight loss and long term weight management.

Long term maintenance of excess body weight loss can be successful if the patient adapts and adheres to a straightforward dietary, supplement, exercise, and behavioral regimen.

Rapid results

Cons

4 out of 10 weight loss patients develop complication within six months

Mortality rates are at 1 in every 200 patients

Life time need for vitamin supplements

Bowel movement problems

Bloating

Flatulence

Risk of nutritional deficiencies

Gallbladder problems

Gallstones

Re-routing of bile, pancreatic and the other digestive juice beyond the stomach can cause intestinal irritation and ulcers.

Close lifelong monitoring for protein, malnutrition, anemia, and bone disease is recommended

Three basic moral principals

1) Should a minor be allowed to undergo bariatric surgery, even though their bodies are still growing and maturing?

2) Should parents not allow the surgery, even knowing the extreme health benefits?

3) Should Doctor’s even recommend the surgery to minors?

Syllogism

People who are morbidly obese have unhealthy lives with life threatening illnesses.

Ricky is morbidly obese.

Ricky has an unhealthy life with life threatening illnesses.

Ethics is larger than law

What if the minor is 16, lives with only the mother, the father is unknown, and the mother is an alcoholic who doesn’t do anything for either herself or the child. The 16 year old pretty much takes care of the house, bills and groceries, while going to school and working a part time job. The mother won’t agree to allow the child to undergo bariatric surgery, despite the Doctor’s recommendation. The child really needs and wants this surgery, even after learning about all the possible outcomes and potential problems. However, law requires that a minor have parental consent to medical procedures. Could the child find some way around the law?

Recommendation  

After considering our theories, it would be recommended that Ricky have the surgery. Since he has tried for many months to lose weight, working with his doctor, and has had limited success; his health is not improving, and he hasn’t even hit adulthood yet. Him and his parents are thoroughly aware of all possible complications and side effects and haven’t rushed into anything. In viewing the long term effects, the surgery would be the most beneficial option for him.

1 and ½ years after the surgery; Ricky walks up the aisle, up the stairs, across the stage, then back down the aisle to his seat; all without stopping to catch his breath. Ricky now weighs 220 lbs, maintains an active lifestyle, and puts lots of thought and care into his diet. He no longer has to worry about the diabetes and has been off his inhaler for 5 months. Ricky has changed for the better not only physically, but mentally. He has great confidence in himself, and loves to hang out with his friends. He still goes to support group for the weight loss, and has been able to become a motivational speaker to others his age with the same problems. He did have to deal with some infection problems the first few months after the surgery, but has had no additional complications since.

Conclusion