Case substantially modified from “Obesity in Kids: When Appeals to Vanity Don’t Work,” Virtual Mentor 8(10): 377-380, October 2006 – see virtualmentor.ama-assn.org
Nicholas has the option of spending the summer in an intensive weight reduction program at a health facility in Ontario. This highly regarded program accepts only 10 adolescents each summer, based on medical problems related to obesity. Nicholas has cardiomegaly, hypertension and pre-diabetes. At 14, Nicholas is 5 feet 7 inches tall and currently weighs 285 pounds.
The health team caring for Nicholas is quite concerned about him and believes that this program would be a great option. While traveling to Ontario and being separated from his family might be hard, the weight reduction program would likely have a very positive benefit on Nicholas’s health.
Indeed, one of the health team members, Matthew, feels strongly about this as he recalls what it was like to be the “fat kid” in class, putting up with the teasing and ridicule. After a family meeting, Matthew is almost incredulous that Nicholas isn’t sure about the program and that his parents aren’t really pushing him to go. He’s overheard saying to Nicholas’s mother on the way out of the meeting that, “I can’t believe that you aren’t sending him to the program. It’s his only chance! Any good parent would send their child.”
Amy, the team social worker, has been meeting with Nicholas and his parents and she shares a different perspective. Amy has noted that Nicholas isn’t really bothered by his weight in the way some other people are. He has his first girlfriend, is pretty popular, and doesn’t get teased very often by his peers (about his weight, at least). His parents are also ok with his body size. While they appreciate his health problems, they are really concerned that an (over)emphasis on his weight might hurt his self-esteem and cause him to lose focus on who he is as a whole person.
Further discussion among team members makes it clear that there is deep disagreement about how to proceed in this case. Should they put more pressure on Nicholas and/or his parents to agree to the camp? Is this over-stepping their role as health care providers? All agree that an ethics perspective would likely be helpful and give the clinical ethics consultation line a call.
