WHILE’S WORDS
Moral challenges Alison While Alison While, Emeritus Professor of Community Nursing, King’s College London, Florence Nightingale Faculty of Nursing and Midwifery and Fellow of the QNI
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National Institute for Health and Care Excellence (2014) Obesity: Identification, assessment and management of overweight and obesity in children, young people and adults. Draft for consultation. NICE Guidelines. http://tinyurl. com/q2hy5my (accessed 8 September 2014) Parliament (2014a) Assisted Dying Bill (HL Bill 6). http://tinyurl.com/osbwv57 (accessed 8 September 2014) Parliament (2014b) Assisted Dying Bill (HL Bill 6): second reading. Lords Hansard Records. http://tinyurl.com/ osbwv57 (accessed 8 September 2014)
518
‘Eat less and move more’ strategies alone will not solve the UK obesity epidemic...we need to consider ways of reducing the downstream costs of untreated obesity
Alison While
© 2014 MA Healthcare Ltd
conomic success and enormous progress in medical treatment has created moral challenges for today’s society. The ageing population reflects both national economic success and progress within health care, which means many are now surviving into their tenth decade— something that was hitherto a rarity. Economic success has also changed population lifestyles characterised by excessive calorie intake and insufficient levels of physical activity. The caring costs of the ageing population—making the distinction between a long life and quality of life—and increasing population obesity have provoked increasing debate. Lord Falconer’s (Parliament, 2014a) Assisted Dying Bill proposing assisted suicide in certain circumstances has enabled a debate on the merits of the current law, which does not permit any assistance with suicide regardless of the circumstances.While most senior religious figures do not support the Bill, Lord Carey (former Archbishop of Canterbury) has changed his position to support the bill on the grounds that it permits loving compassion by enabling people to fulfil their stated wish. However, as might be expected, the opposition to the Bill is as vociferous as its supporters (Parliament, 2014b). Among others, Baroness Finlay (Llandaff) and Baroness Campbell (Surbiton), who has spinal muscular atrophy, highlight the Bill’s flaws and the potential for drift towards euthanasia regardless of the wishes of the vulnerable. Baroness Finlay even reminded their Lordships that 176 cremation forms of Dr Harold Shipman’s patients were countersigned by a second doctor. Indeed, the dangerous position in which any change in legislation places medical and other health professions needs to be carefully considered as the debate continues. Another topic that has caused heated debate is the National Institute for Health and Care Excellence (NICE) proposal that people with a body mass index of 30–35 who have newly diagnosed diabetes should be considered for bariatric surgery. About 8000 people have bariatric surgery each year, but the new proposals may at least double this number. However, little has been said about the complications of bariatric surgery and that it is not a cureall, although it can be a very successful treatment for some. The proposal has brought various biases into the open, with claims that money spent on bariatric surgery could be better deployed, especially where all treatments and services are in competition within a resource-constrained system.Perhaps the proposal also signals the admission that ‘eat less and move more’ strategies alone will not solve the UK obesity epidemic and that we need to consider ways of reducing the downstream costs of untreated obesity, including those related to diabetes and other complications of obesity until there is a widespread change in lifestyles. This debate is challenging for health professionals who are required to treat all patients equally despite holding various personal beliefs about the individual’s responsibility for health behaviours and their consequences. BJCN
British Journal of Community Nursing October 2014 Vol 19, No 10
Journal of Community Nursing. Downloaded from magonlinelibrary.com by 138.253.100.121 on November 26, 2015. For personal use only. No other uses without permission. . All rights re
Moral challenges Alison While Alison While, Emeritus Professor of Community Nursing, King’s College London, Florence Nightingale Faculty of Nursing and Midwifery and Fellow of the QNI
E
National Institute for Health and Care Excellence (2014) Obesity: Identification, assessment and management of overweight and obesity in children, young people and adults. Draft for consultation. NICE Guidelines. http://tinyurl. com/q2hy5my (accessed 8 September 2014) Parliament (2014a) Assisted Dying Bill (HL Bill 6). http://tinyurl.com/osbwv57 (accessed 8 September 2014) Parliament (2014b) Assisted Dying Bill (HL Bill 6): second reading. Lords Hansard Records. http://tinyurl.com/ osbwv57 (accessed 8 September 2014)
518
‘Eat less and move more’ strategies alone will not solve the UK obesity epidemic...we need to consider ways of reducing the downstream costs of untreated obesity
Alison While
© 2014 MA Healthcare Ltd
conomic success and enormous progress in medical treatment has created moral challenges for today’s society. The ageing population reflects both national economic success and progress within health care, which means many are now surviving into their tenth decade— something that was hitherto a rarity. Economic success has also changed population lifestyles characterised by excessive calorie intake and insufficient levels of physical activity. The caring costs of the ageing population—making the distinction between a long life and quality of life—and increasing population obesity have provoked increasing debate. Lord Falconer’s (Parliament, 2014a) Assisted Dying Bill proposing assisted suicide in certain circumstances has enabled a debate on the merits of the current law, which does not permit any assistance with suicide regardless of the circumstances.While most senior religious figures do not support the Bill, Lord Carey (former Archbishop of Canterbury) has changed his position to support the bill on the grounds that it permits loving compassion by enabling people to fulfil their stated wish. However, as might be expected, the opposition to the Bill is as vociferous as its supporters (Parliament, 2014b). Among others, Baroness Finlay (Llandaff) and Baroness Campbell (Surbiton), who has spinal muscular atrophy, highlight the Bill’s flaws and the potential for drift towards euthanasia regardless of the wishes of the vulnerable. Baroness Finlay even reminded their Lordships that 176 cremation forms of Dr Harold Shipman’s patients were countersigned by a second doctor. Indeed, the dangerous position in which any change in legislation places medical and other health professions needs to be carefully considered as the debate continues. Another topic that has caused heated debate is the National Institute for Health and Care Excellence (NICE) proposal that people with a body mass index of 30–35 who have newly diagnosed diabetes should be considered for bariatric surgery. About 8000 people have bariatric surgery each year, but the new proposals may at least double this number. However, little has been said about the complications of bariatric surgery and that it is not a cureall, although it can be a very successful treatment for some. The proposal has brought various biases into the open, with claims that money spent on bariatric surgery could be better deployed, especially where all treatments and services are in competition within a resource-constrained system.Perhaps the proposal also signals the admission that ‘eat less and move more’ strategies alone will not solve the UK obesity epidemic and that we need to consider ways of reducing the downstream costs of untreated obesity, including those related to diabetes and other complications of obesity until there is a widespread change in lifestyles. This debate is challenging for health professionals who are required to treat all patients equally despite holding various personal beliefs about the individual’s responsibility for health behaviours and their consequences. BJCN
British Journal of Community Nursing October 2014 Vol 19, No 10
Journal of Community Nursing. Downloaded from magonlinelibrary.com by 138.253.100.121 on November 26, 2015. For personal use only. No other uses without permission. . All rights re
